J Korean Neurosurg Soc.  2011 Apr;49(4):241-244. 10.3340/jkns.2011.49.4.241.

Sparganosis in the Lumbar Spine : Report of Two Cases and Review of the Literature

Affiliations
  • 1Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. swroh@amc.seoul.kr
  • 2Department of Pathology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
  • 3Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

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.

Keyword

Sparganosis; Sparganosis in the lumbar vertebrae; Enzyme-linked immunosorbent assay

MeSH Terms

Acute Pain
Adhesives
Adult
Arachnoid
Arachnoiditis
Biopsy
Cauda Equina
Central Nervous System
Conus Snail
Enzyme-Linked Immunosorbent Assay
Epidural Space
Erectile Dysfunction
Female
Granulation Tissue
Humans
Inflammation
Laminectomy
Magnetic Resonance Spectroscopy
Male
Middle Aged
Parasites
Snakes
Sparganosis
Sparganum
Spine
Urinary Incontinence
Adhesives
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