title: Sparganosis in the lumbar spine : report of two cases and review of the literature.
abstract: Sparganosis is a rare parasitic infection affecting various organs, including the central nervous system, especially the lumbar epidural space. This report describes the identification of disease and different strategies of treatments with preoperative information. A 42-year-old man presented with a 2-year history of urinary incontinence and impotence. He had a history of ingesting raw frogs 40 years ago. Magnetic resonance (MR) imaging showed an intramedullary nodular mass at conus medullaris and severe inflammation in the cauda equina. A 51-year-old woman was admitted with acute pain in the left inguinal area. We observed a lesion which seemed to be a tumor of the lumbar epidural space on MR imaging. She also had a history of ingesting inadequately cooked snakes 10 years ago. In the first patient, mass removal was attempted through laminectomy and parasite infection was identified during intra-operative frozen biopsy. Total removal could not be performed because of severe arachnoiditis and adhesion. We therefore decided to terminate the operation and final histology confirmed dead sparganum infection. We also concluded further surgical trial for total removal of the dead worm and inflammatory grannulation totally. However, after seeing another physician at different hospital, he was operated again which resulted in worsening of pain and neurological deficit. In the second patient, we totally removed dorsal epidural mass. Final histology and enzyme-linked immunosorbent assay (ELISA) confirmed living sparganum infection and her pain disappeared. Although the treatment of choice is surgical resection of living sparganum with inflammation, the attempt to remove dead worm and adhesive granulation tissue may cause unwanted complications to the patients. Therefore, the result of preoperative ELISA, as well as the information from image and history, must be considered as important factors to decide whether a surgery is necessary or not.
authors: Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors: Jin Hoon
authors: JH
authors: Park
authors: Young Soo
authors: YS
authors: Park
authors: Jong Sung
authors: JS
authors: Kim
authors: Sung Woo
authors: SW
authors: Roh
references: Neuroradiology. 1992;34(3):241-4
references: 1630620
references: Clin Neurol Neurosurg. 1998 Jun;100(2):148-52
references: 9746305
references: Arch Neurol. 2004 Jul;61(7):1126-8
references: 15262748
references: Kisaengchunghak Chapchi. 1975 Jun;13(1):60-77
references: 12913468
references: J Neurosurg. 1989 Aug;71(2):290-2
references: 2746355
references: Kisaengchunghak Chapchi. 1984 Dec;22(2):222-228
references: 12891016
references: Neurosurgery. 1987 Aug;21(2):235-8
references: 3309711
references: Clin Neurol Neurosurg. 2008 Sep;110(8):843-6
references: 18617320
references: Intern Med J. 2002 Nov;32(11):541-53
references: 12412938
references: J Magn Reson Imaging. 1998 Mar-Apr;8(2):297-307
references: 9562056