Intracranial fungal infection of sinonasal origin

doi:10.3969/j.issn.1672-6731.2020.12.010

Abstract

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.

Key words: Central nervous system fungal infections, Paranasal sinuses, Neurosurgical procedures, Endoscopy

摘要：

目的探讨源于鼻-鼻窦的颅内真菌感染临床和影像学特点，总结诊断与治疗经验。方法与结果 2004年11月至2019年7月共诊断与治疗15例源于鼻-鼻窦的颅内真菌感染患者，临床主要表现为头痛和单眼视力下降，既往可伴有鼻-鼻窦手术史（9例）。CT可见颅底骨质缺损，MRI增强扫描病灶呈明显强化。采取经颅入路（8例）、经鼻内镜（4例）或经颅入路联合经鼻内镜（2例）手术切除炎症性病灶，重症者行腰大池引流术（1例）；病灶全切除3例、近全切除7例、部分切除4例。经组织病理和真菌培养诊断为真菌性肉芽肿（9例，曲霉菌感染6例、白色假丝酵母菌感染2例、毛霉菌感染1例）、真菌性脑脓肿（4例，曲霉菌感染3例、毛霉菌感染1例）、弥漫性真菌性脑膜炎（2例，曲霉菌感染1例、白色假丝酵母菌感染1例）。抗真菌药物治疗3~36个月，中位时间9.10（6.00，10.70）个月，随访6个月至14年，3例死亡。结论源于鼻-鼻窦的颅内真菌感染主要表现为颅内真菌性肉芽肿或真菌性脑脓肿，致病菌以曲霉菌居多，头痛为最常见症状，手术切除病灶同时应维持鼻窦引流通畅，术后需长程抗真菌药物治疗并长期随访。

关键词: 中枢神经系统真菌感染, 鼻窦, 神经外科手术, 内窥镜检查

LI Yong, ZHANG Tian-ming, QIU E, ZHANG Jia-liang, ZHAO Jing-wu, LIU Hao-cheng, XU Yong, SUN Bo-wen, LIU Hong-gang, KANG Jun. Intracranial fungal infection of sinonasal origin[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(12): 1085-1091.

李永, 张天明, 邱锷, 张家亮, 赵景武, 刘浩成, 徐勇, 孙博文, 刘红刚, 康军. 鼻源性颅内真菌感染临床分析[J]. 中国现代神经疾病杂志, 2020, 20(12): 1085-1091.

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