Intracranial fungal granuloma

• Published in: Surgical neurology 1997-05, Vol.47 (5), p.489-497
• Main Authors: Sharma, B.S., Khosla, V.K., Kak, V.K., Banerjee, A.K., Vasishtha, R.K., Prasad, K.S.Manjunath, Sharma, S.C., Mathuriya, S.N., Tewari, M.K., Pathak, A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aspergillus; Brain Diseases - microbiology; Brain Diseases - mortality; Brain Diseases - surgery; Child; Female; fungal infection; granuloma; Granuloma - microbiology; Granuloma - mortality; Granuloma - surgery; Humans; Male; Middle Aged; mycoses; Mycoses - mortality; Mycoses - surgery; Retrospective Studies; Survival Analysis; Treatment Outcome
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/S0090-3019(96)00209-1

Intracranial fungal granulomas are uncommon and their pathogenesis, clinical picture, and effectiveness of therapy remains unclear. Thirty-two cases were studied retrospectively in two groups: (1) Rhinocerebral group (22 cases) had a chronic paranasal sinus (PNS) disease with secondary involvement of skull base, cranial nerves, and/or brain. The granulomas were adherent to dura, firm, avascular, and tough, requiring a knife to cut. (2) Primary intracranial group (10 cases) had no detectable PNS lesion at initial presentation. The granulomas were soft, suckable, and contained pus or necrotic material. Postoperative and overall mortality were 37.5% and 50%, respectively. Meningoencephalitis was the most common cause of death. Altered sensorium, pus in the granuloma, and/or severe brain edema were poor prognostic factors. All survivors except four have symptomatic residual or recurrent lesions. Early diagnosis with MRI or stereotactic biopsy, radical surgery, and high dose and chronic suppressive chemotherapy may improve overall results in these cases.