Cranial and intracranial aspergillosis of sino-nasal origin

Abstract

This paper is an attempt at defining the most efficacious surgical and antifungal therapy for invasive cranial and intracranial aspergillosis, and is based on experience with nine non-immunocompromised patients treated and followed-up by the authors between 1983 and 1994; as well as on the summary of previously reported cases and advances in therapy of this condition. Depending on the degree of aspergillar involvement of the cranial base and intracranial structures, a classification, with implications for treatment and prognosis, is also proposed. Two patients had extracranial skull base erosion; whereas relentlessly progressive granulomas, mimicking malignancy, invaded the skull base and intracranial contents in seven cases. Of these seven patients with cranial and intracranial invasion, two died of acute intracranial haemorrhage due to fungal invasion of cerebral blood vessels. In two patients, complete surgical eradication of the disease proved impossible due to cavernous sinus involvement, while residual aspergillomas are still present in orbit and paranasal sinuses (PNS) in a further two patients in spite of multiple surgical procedures and prolonged antifungal chemotherapy (AFC). What appears to be a cure has been effected in one patient only. Multiple therapeutic strategies were used. Biopsy plus systemic AFC was ineffective, surgical drainage and debridement plus systemic AFC resulted in long-term survivals but no cure. Radical surgery in conjunction with systemic and local (intracavitary) AFC should be considered to improve an otherwise poor prognosis.

Chronic invasive aspergillosis of the paranasal sinuses in immunocompetent hosts from Saudi Arabia.

“…Partial, subtotal, staged, or repeated debridement combined with antifungal treatment was associated with high failure rates. 12,21,24,26,35 There was a tendency for lower relapse rate (40%) in patients who had complete surgical evacuation compared to patients receiving incomplete evacuation (77%).…”

“…The syndrome has also been noted in Saudi Arabia. [26][27][28][29][30] Our center receives cases referred from all over the country. Most cases in this series came from the southwestern region of Saudi Arabia.…”

“…12,[24][25][26] The current report also identified the frequency of relapse after surgical evacuation and the mean time to the first relapse after first surgery. However, none of the evaluated variables was identified as a statistically significant risk factor predisposing to relapse.…”

“…Nevertheless, outcome is poor and the disease frequently relapses. 12,[24][25][26] Risk factors for relapse in spite of complete surgical evacuation have not been previously evaluated.…”

Intracranial Invasive Aspergillosis Originating in the Sphenoid Sinus: A Successful Treatment with High-Dose Itraconazole in Three Cases

“…Once the intracranial invasion of infection occurs, this form of aspergillus infection is difficult to control with conventional antifungal and surgical therapies and the mortality is notoriously high (Tsuboi et al 1988;Denning 1996;Naim et al 1996;Okada et al 1998;Takahashi et al 1998;Murthy et al 2000;Hurst et al 2001).…”