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Fig. 3.120 Internal carotid arteriograms in two different patients with large hydatid cysts of the brain. In the first patient (A, B and C), there is a large non-calcified left frontoparietal hydatid which has caused diastasis of the cranial sutures, especially the coronal sutures. (A) Anteroposterior and (B) left lateral views of the skull obtained during left carotid arteriography show marked shift of the anterior cerebral artery across the midline towards the right side as well as inferior displacement of the middle cerebral artery. No neovascularity is identified. (C) Lateral view of the skull of the same patient during the venous phase of the arteriogram shows the vein of Trolard is angulated and displaced posteriorly. (D) Lateral view of the skull obtained during carotid arteriography in another patient, a South African child with a huge temporal fossa hydatid cyst. The large mass extends into the parietal-occipital region with draping, stretching, and elevation of the middle cerebral artery. The anterior cerebral artery is also somewhat stretched, suggesting moderate hydrocephalus. There is slight diastasis of the coronal and lambdoidal sutures. (D courtesy of the University of Cape Town Radiology Library).

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Fig. 3.121 (A and B) PA and lateral views of the skull of a South African patient show a well-defined rim of sclerosis about a small, round, lytic hydatid lesion involving the right frontal bone. (C and D) AP and lateral views from a right internal carotid arteriogram reveals marked displacement of the anterior cerebral artery across the midline on the AP view as well as posterior displacement on the lateral projection secondary to a right frontal cerebral hydatid cyst. (Courtesy of the University of Cape Town Radiology Library).