Intracranial fungal infection of sinonasal origin

Abstract

Objective To investigate the clinical features, diagnosis and surgical treatment of intracranial fungal infections of sinonasal origin. Methods and Results In this retrospective study, clinical data of 15 cases who were diagnosed as intracranial fungal infection from November 2004 to July 2019 at Department of Neurosurgery, Beijing Tongren Hospital were analyzed. Nine cases have a history of paranasal sinus surgery. Headache and visual disturbance were major presenting clinical features. Neurosurgical operations were performed in 14 patients: 8 cases were operated by the transcranial approach (2 cases by eyebrow incision), 4 cases by endoscopic sinus surgery, 2 cases by combined approach. Lumbar cistern drainage was performed in one case. All 15 patients were treated with antifungal treatment. Intracranial fungal granuloma (IFG) was in 9 cases, intracranial fungal abscess in 4 cases, diffuse fungal meningitis in 2 cases. Total resection was performed in 3 cases and subtotal resection was in 7 cases, and partial resection or biopsy was in 4 cases. Diagnosis of intracranial fungal infection was established by the histopathological analysis and/or fungal cultures. Aspergillus (10 cases) was the most common pathogen, followed by Candida albicans (3 cases), and Mucor (2 cases). During a follow⁃up period of 6 months to 14 years, 2 cases recurred and reoperated, 3 cases died. Conclusions Intracranial fungal infections of sinonasal origin may take the form of fungal granuloma or abscess formation. The morbidity and mortality are high. Aspergillus is the most common pathogen. Headache is the most common symptom. Preoperative diagnosis is difficult. The drainage of sinuses should be unobstructed. Frozen pathological examination during the operation can make a clear diagnosis in the early stage. Long⁃term antifungal treatment and long⁃term follow⁃up are needed after the operation. DOI：10.3969/j.issn.1672⁃6731.2020.12.010

Keywords

• central nervous system fungal infections
• paranasal sinuses
• neurosurgical procedures
• endoscopy