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.

/ / Recommend / Download Citations

URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2020.12.010

https://journal11.magtechjournal.com/cjcnn/EN/Y2020/V20/I12/1085

References

[1] Siddiqui AA, Shah AA, Bashir SH. Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients:clinical spectrum and outcome in 25 cases[J]. Neurosurgery, 2004, 55:602-611.
[2] Mishra A, Prabhuraj AR, Shukla DP, Nandeesh BN, Chandrashekar N, Ramalingaiah A, Arivazhagan A, Bhat DI, Somanna S, Devi BI. Intracranial fungal granuloma:a single-institute study of 90 cases over 18 years[J]. Neurosurg Focus, 2019, 47:E14.
[3] Selvam M, Pande A, Chakravarthy VM, Ramamurthi R. Invasive rhino-cerebral fungal granuloma[J]. Neurol India, 2010, 58:270-276.
[4] Liu HG, Piao YS. Pathological diagnosis of fungal infections of nasal cavity and paranasal sinuses[J]. Zhen Duan Bing Li Xue Za Zhi, 2009, 16:1-5.[刘红刚, 朴颖实. 重视鼻腔鼻窦真菌感染的病理诊断[J]. 诊断病理学杂志, 2009, 16:1-5.]
[5] Cheng W, Wei JJ, Wang RZ, Ren ZY. The diagnosis and treatment of fungal infections in central nervous system[J]. Ji Chu Yi Xue Yu Lin Chuang, 2012, 32:358-361.[程卫, 魏俊吉,王任直, 任祖渊. 中枢神经系统真菌感染诊断治疗进展[J]. 基础医学与临床, 2012, 32:358-361.]
[6] Feng ES, Liang TY, Cao Y, Li PL, Liang B, Wang XY, Chen SC, Sun JD, Wang F. Clinical diagnosis and treatment of intracranial fungal infection[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2018, 34:596-600.[冯恩山, 梁庭毓, 曹杨, 李培亮, 梁博, 王小永, 陈世超, 孙际典, 王芳. 中枢神经系统真菌感染的临床诊治[J]. 中华神经外科杂志, 2018, 34:596-600.]
[7] Naik V, Ahmed FU, Gupta A, Garg A, Sarkar C, Sharma B, Mahapatra AK. Intracranial fungal granulomas:a single institutional clinicopathologic study of 66 patients and review of the literature[J]. World Neurosurg, 2015, 83:1166-1172.
[8] Dubey A, Patwardhan RV, Sampth S, Santosh V, Kolluri S, Nanda A. Intracranial fungal granuloma:analysis of 40 patients and review of the literature[J]. Surg Neurol, 2005, 63:254-260.
[9] Xiang CY, Liang ZP, Zhang J, Hu JH. Analysis on the characteristics of CT and MR about fungal meningitis and intracranial fungal granuloma[J]. Zhongguo Yi Xue Zhuang Bei, 2018, 15:51-54.[向成燕, 梁志鹏, 张俊, 胡家海. 真菌性脑膜炎与颅内真菌性肉芽肿的CT和MR表现特点分析[J]. 中国医学装备, 2018, 15:51-54.]
[10] Zhang ZY, Wang HD, Fan YW, Li J, Wang XL, Wang H. Diagnosis and surgical treatment of intracranial fungal granuloma[J]. Zhongguo Wei Qin Xi Shen Jing Wai Ke Za Zhi, 2015, 20:71-73.[张治元, 王汉东, 樊友武, 李杰, 王笑亮, 王海. 颅内真菌性肉芽肿的诊断及外科治疗[J]. 中国微侵袭神经外科杂志, 2015, 20:71-73.]
[11] Yang BT, Wang ZC, Liu S, Xian JF, Zhang ZY, Liu ZL, Lan BS. Diagnosis and surgical treatment of intracranial fungal granuloma[J]. Zhonghua Fang She Xue Za Zhi, 2005, 39:826-830.[杨本涛, 王振常, 刘莎, 鲜军舫, 张征宇, 刘中林, 兰宝森. 慢性侵袭性真菌性鼻窦炎的CT和MRI诊断[J]. 中华放射学杂志, 2005, 39:826-830.]
[12] Bloch KC, Bailin SS. Update on fungal infections of the central nervous system:emerging pathogens and emerging diagnostics[J]. Curr Opin Infect Dis, 2019, 32:277-284.
[13] Li DM, Fang GL, Wang L, Ma FR. A case of emergency treatment for nasal sinus-orbit-brain fungal infection[J]. Zhonghua Yi Xue Za Zhi, 2009, 89:712-714.[李东明, 房高丽,王丽, 马芙蓉. 鼻-眼眶-脑真菌感染一例抢救体会[J]. 中华医学杂志, 2009, 89:712-714.]

[1]	Neurosurgical Branch, Chinese Medical Association, Chinese Neurosurgical Intensive Care Management Collaborative Group. Chinese expert consensus on the use of sulbactam to treat patients infected with Acinetobacter baumannii in the neurosurgical intensive care unit [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(6): 407-424.
[2]	Xiao ZHANG, Rui YIN, Peng-tao LI, Jian-bo CHANG, Si-shuai SUN, Jun-ji WEI. Therapeutic effects of neuroendoscopic surgery and burr hole hematoma drainage combined with urokinase in the treatment of septated chronic subdural hematoma [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(6): 455-460.
[3]	Ruo-dong HAN, Ya-fei ZHANG, Xiu-xia YAN, Bo-wen LI, Bei-li QIAN. Therapeutic efficacy of a novel simple manual bone cone drilling hematoma drainage for hypertensive intracerebral hemorrhage [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(6): 461-470.
[4]	Pin-fei NI, Si-yuan FAN, Jia LI, Hui YOU, Da-chun ZHAO, Hai-tao REN, Hong-zhi GUAN. Central nervous system aspergillosis [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(4): 258-264.
[5]	Xing LU, Xiao-chen ZHANG, Huan-xin YU, Xiang ZHAI, Wei HANG, Gang LIU. Correlation analysis between quality of life and clinical symptoms and imaging features in patients after endoscopic transnasal or transoral approach for resection of skull base chordoma [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(3): 182-187.
[6]	Pei-jian WANG, Ming WEI. Prevention and management strategies of cardiovascular and cerebrovascular comorbidity [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(2): 106-112.
[7]	Xiao-guang TONG, Ming-gang SHI. More attention on synchronous intervention on cardiovascular and cerebrovascular diseases by neurosurgeon and cardiologist [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(1): 1-4.
[8]	Ming-gang SHI, Xiao-guang TONG. Synchronous surgical treatment for brain and heart of cardiovascular and cerebrovascular diseases [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(1): 17-21.
[9]	Tao HONG, Bin TANG. How to become an excellent skull base surgeon [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 571-574.
[10]	Chen ZHANG, Yan-ming ZHANG, Xiao-guang TONG. Application of endoscopic transnasal approach combined with microscopic craniotomy in complex skull base tumors with nasal cranial communication [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 575-579.
[11]	Jun-qi LIU, Li WANG, Zhen-lin WANG, Qiu-hang ZHANG, Yan QI, Wei WEI. Endoscopic resection of skull base chordoma via the combined oral and nasal approach [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 580-585.
[12]	Liang JIA, Hang ZHOU, Xiao-wei ZHANG, Qing-jiu ZHANG, Zhong-qiang LÜ. Extended endoscopic endonasal approach in resection of suprasellar invasive pituitary adenoma [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 586-590.
[13]	Jing LI, Huan-kang ZHANG, Quan LIU, Ye GU, Kai XUE, Xi-cai SUN, Hong-meng YU. Endoscopic transoral - medial pterygomandibular fold approach anatomic study for jugular foramen [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 591-598.
[14]	Min WEI, Qi-jia ZHAN, Wen-bin JIANG, Sen LI, Chen LIU, Bo XIAO. Efficacy of endoscopic strip craniectomy for sagittal synostosis [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 621-626.
[15]	Kai LUO, Sheng ZHU, Ke LU, Sheng-tian WU, Jie-min YAO, Huang-de FU. Feasibility analysis of long-tunnelled external ventricular drainage in neurosurgery [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(6): 509-514.

Please choose a citation manager

Content to export