Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years (original) (raw)
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World neurosurgery, 2015
Fungal granulomas of the central nervous system are rare, and have high mortality and morbidity irrespective of treatment. The authors report their experience of managing 66 patients over 15 years and discuss the clinical, radiological, surgical and pathological findings. This is among the largest reported series. A retrospective analysis was performed on patients with intracranial fungal granulomas (ICFGs), treated in our institution, between January 1997 and May 2011. Only mass forming histopathologically proven ICFG were included in this study. The age of the patients ranged from 7 years to 67 years (mean= 32.3 yrs) and most patients were in the third and fourth decades of life. The study population had 47 males and 19 females. The most common symptom was headache (41 patients), followed by vomiting (16 patients) and blurring of vision (16 patients). Only 3 patients had fever as a presenting feature. The duration of symptoms was less than 6 months in all cases and less then 3 mon...
Intracranial fungal granuloma: analysis of 40 patients and review of the literature
Objective: To describe the characteristics of patients diagnosed with intracranial fungal granuloma (IFG) in the largest reported series to date (to our knowledge). Methods: A 22-year retrospective, multi-institutional review of 40 patients, aged 16 to 62 years (mean, 40.2 years), was performed in patients with histopathologically confirmed IFG. The variables were symptoms/signs at presentation, predisposing factors, location of granuloma, involvement of paranasal sinuses, diagnostic studies including blood and urine cultures, surgical procedures performed, specific organism identified, treatment, and prognosis. Plain x-rays, computed tomography, and/or magnetic resonance imaging scans were performed. Results: Predominant symptoms included headache (83%), vomiting (65%), proptosis (48%), and visual disturbances (48%). Other symptoms were fever, nasal congestion, and seizures (7 [18%]). Common signs included papilledema (12 [30%]), with cranial neuropathy (I, III/IV/VI, and V in 4, 7, and 2 patients, respectively), hemiparesis (3), and meningismus (3). Predisposing factors were diabetes (16 [40%]), tuberculosis (7 [18%]), and immunocompromise related to renal transplant (2), non-Hodgkin's lymphoma (1), and human immunodeficiency virus (1). Location was primarily frontal (10 [25%]), with anterior cranial fossa involved in 8 (20%) patients; 6 (15%) patients had sellar/parasellar involvement. Eighteen (40%) had paranasal sinus involvement. Twenty-nine patients underwent craniotomy for resection, with 11 undergoing biopsy (of which 3 were transsphenoidally approached). Histopathology revealed aspergilloma (25 [63%]), mucormycosis (7 [18%]), cryptococcoma (3), cladosporidium (3), Bipolaris hawaiiensis (1), and Candida species(1). Microbiological analysis of the specimen was positive in 28 (60%) patients. All patients were treated with amphotericin B, fluconazole, and/or flucytosine. Only 26 patients completed amphotericin B therapy (due to nephrotoxicity). Mortality was 63%, most commonly due to meningoencephalitis (16 [36%]). Conclusions: High index of suspicion of IFG should exist for the following groups: (1) immunocompromised patients with intracranial lesions and (2) diabetic patients with intracranial and rhinocerebral mass lesions. Early diagnosis, surgical decompression, and a complete course of promptly initiated antifungal therapy are associated with better prognosis. D
Outcome of Two Treatment Regimens in the Management of Intracranial Fungal Granuloma
Pakistan Journal Of Neurological Surgery, 2017
Objective: Two treatment regimens means either you have to completely/near total excise the granuloma with sinus clearances (extra-dural) OR don’t touch it, even minimal invasive procedure such as burr hole biopsy can be fatal (intra-dural). Introduction: The diagnosis of intracranial fungal granuloma almost always remained a challenge for neurosurgeons because of their rarity, alter behavior and lack of diagnostic tools. These infections are now easily diagnosed because of increased awareness and understanding regarding this pathology, better diagnostic tools and an increase in immunocompromised/immunocompetent hosts (from any cause). Most often, the fungal granulomas are due to contiguous spread of the infection from the paranasal sinuses and ear. Rarely, they may be due to hematogenous spread from a focus in the lungs. The infection can spread from sinuses to invade the brain parenchyma. Once it involves the brain parenchyma then the course of the disease is fulminant. Contrast e...
2020
Introduction Objective: MRI and outcome based learning experience in the management of intracranial fungal granulomas and atypical brain infections (IFG) considering risk versus benefit before neurosurgical interventions. Methods: We performed a retrospective analysis of all patients with diagnosed IFG or anticipated diagnosis based predominantly on imaging from 2011 to 2019 collected data included clinical history, lab results treatment and review of all imaging studies performed. Among these cases, one case required additional consideration of histopathological confirmation due to refractory response to antifungal medication and subsequent deterioration of neurology of patient hence neurosurgical intervention was done in that individual case. The variables were symptoms and signs at presentation, predisposing factors, location of granuloma, involvement of paranasal sinuses, diagnostic studies including blood and urine cultures, septic profile, surgical procedure performed along wi...
IRJNS Journal, 2020
Background and Importance: Fungal infections of the Central Nervous System (CNS) usually present as subacute meningitis or intracranial space-occupying lesion with mass effect on surrounding structures and consequent focal neurological deficits. Intracranial fungal granulomas are often misdiagnosed clinically and radiologically as neoplastic lesions. Biopsy of the lesion is the only reliable technique to establish the correct diagnosis as well as to detect the causative fungal species. Voriconazole (VZ) is a broad-spectrum triazole antifungal agent. It can be given orally and intravenously and has lesser adverse effects. Case Presentation: In this article, we report a series of 6 cases of biopsy-proven fungal granuloma with varied clinical and radiological presentations who were given treatment with voriconazole for 6 months and demonstrated favorable response. Out of 6 patients (4 males and 2 females), 1 was immunocompromised Diabetes Mellitus (DM) with uncontrolled hyperglycemia). Headache was the most commonly observed symptom. Paranasal sinus and anterior cranial fossa were the most commonly affected site. Four patients received voriconazole therapy for 12 months and 1 received the same for 6 months before showing clinical resolution of disease. There was 1 death in the study group from non-related medical complications. Conclusion: Our series focuses on the correct diagnosis of fungal granuloma which can be achieved by biopsy and clinical evidence of the efficacy of voriconazole against intracranial fungal granuloma.
2008
Background: Involvement of the brain by Aspergillus fumigatus, named as invasive aspergillosis, is extremely rare. Definitive diagnosis needs isolation of the fungus from the tissue specimens and its culture. The disease is very resistant to treatment and quickly becomes fatal despite antifungal chemotherapy with AmB preparations, the drugs of choice for the infection. Case Description: We hereby present a unique case of fungal granuloma of the brain due to A fumigatus, which was cured successfully by intensive antifungal treatment, along with a brief literature review. Conclusions: Although it is rare, we draw the attention to the fact that early diagnostic procedures with rapid confirmation of Aspergillus infection and an early initiation of therapy are pivotal for a benign clinical course in such cases. A complete regression of the disease could be achieved with medical therapy alone with conventional AmB or liposomal AmB combined with oral itraconazole even if a total surgical excision of the lesions could not be performed in complicated cases, as in our patient.
Chronic Invasive Fungal Granuloma–A Diagnostic Dilemma in an Immunocompetent Host
Iranian Journal of Otorhinolaryngology, 2016
Introduction: Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, not only in immunocompromised patients but also in immunocompetent patients. The changing prevalence towards immunocompetent hosts is due to the indiscriminate usage of broad spectrum antibiotics, steroids, and immunosuppressive drugs. Diagnosing invasive fungal sinusitis should not pose any difficulty to both the clinician [a whitish colour secretion in elderly Diabetics, and CT Scan PNS showing concretion in the sinus along with destruction of the surrounding bone] and to the pathologist; however, when the invasive fungal sinus infection presents in a form of a granuloma then its diagnosis imposes a challenge to medical professionals. Case Report We are presenting a case study,which consists of 3 cases of chronic invasive fungal sinus infection.Two patients were treated for tuberculoma and had completed a course of Anti Koch’s Treatment and one patient was given a tria...
Mycoses, 2019
Invasive fungal infections (IFI) of the Central Nervous System (IFI-CNS) and Paranasal Sinuses (IFI-PS) are rare, life-threatening infections in haematologic patients, and their management remains a challenge despite the availability of new diagnostic techniques and novel antifungal agents. In addition, analyses of large cohorts of patients focusing on these rare IFI are still lacking. Between January 2010 and December 2016, 89 consecutive cases of Proven (53) or Probable (36) IFI-CNS (71/89) and IFI-PS (18/89) were collected in 34 haematological centres. The median age was 40 years (range 5-79); acute leukaemia was the most common underlying disease (69%) and 29% of cases received a previous allogeneic stem cell transplant. Aspergillus spp. were the most common pathogens (69%), followed by mucormycetes (22%), Cryptococcus spp. (4%) and Fusarium spp. (2%). The lung was the primary focus of fungal infection (48% of cases). The nervous system biopsy was performed in 10% of IFI-CNS, and a sinus biopsy was performed in 56% of IFI-PS (P = 0.03). The Galactomannan test on cerebrospinal fluid has been performed in 42% of IFI-CNS (30/71), and it was positive in 67%. Eighty-four pts received a first-line antifungal therapy with Amphotericine B in 58% of cases, Voriconazole in 31% and both in 11%. Moreover, 58% of patients received 2 or more lines of therapy and 38% were treated with a combination of 2 or more antifungal drugs. The median duration of antifungal therapy was 60 days (range 5-835). A surgical intervention was performed in 26% of cases but only 10% of IFI-CNS underwent neurosurgical intervention. The overall response rate to antifungal therapy (complete or partial response) was 57%, and 1-year overall survival was 32% without significant differences between IFI-CNS and IFI-PS. The overall mortality was 69% but the IFI attributable mortality was 33%. Mortality of IFI-CNS/PS remains high but, compared to previous historical data, it seems to be reduced probably due to the availability of newer antifungal drugs. The results arising from this large contemporary cohort of cases may allow a more effective diagnostic and therapeutic management of these very rare IFI complications in haematologic patients.
Fungal Infection of the Sinus and Anterior Skull Base
Medical Journal of The Islamic Republic of Iran, 2008
Background: Invasive fungal infection is an opportunistic infection caused commonly by mucoraccae and aspergillus. It mostly occurs in patients with underlying disease. Since it has a high mortality and morbidity rate, considering a treatment strategy seems necessary. Objective: Since there has not been a clear protocol for treating these patients, we decided to establish a protocol for fungal infection of sinus and anterior skull base management. Methods: This retrospective and descriptive case study series included 30 patients. After confirming the pathogen, the authors came to a proper protocol for treatment which is mentioned later. Results: The site involvement included nose and orbital cavity (53.3%), anterior skull base and brain in conjunction with sinonasal (36.6%) and simple nasal cavity involvement (10%). 86.6% of the patients had underlying diseases. 56.6% of patients had diabetes as a single underlying disease, while 13.3% had both diabetes and r...