Case Series
Volume 12 Issue 11 - 2020
Diagnostic Dilemma of Intracranial Fungal Granuloma Risk Versus Benefit Assessment Before Neurosurgical Management
Saeed Mazher*, Abdul Ali Khan, Zaheen Shibli, Abdul Lateef Soneja, Shafatullah and Ahmed Ali
Neurosurgery Neurology and Plastic Surgery Department, Baqai University Hospital, Pakistan
*Corresponding Author: Saeed Mazher, Neurosurgery Neurology and Plastic Surgery Department, Baqai University Hospital, Pakistan.
Received: September 25, 2020; Published: October 30, 2020


Objective: MRI and outcome based learning experience in the management of intracranial fungal granulomas and atypical brain infections (IFG) considering risk versus benefit before neurosurgical interventions.

Methods: We performed a retrospective analysis of all patients with diagnosed IFG or anticipated diagnosis based predominantly on imaging from 2011 to 2019 collected data included clinical history, lab results treatment and review of all imaging studies performed. Among these cases, one case required additional consideration of histopathological confirmation due to refractory response to anti-fungal medication and subsequent deterioration of neurology of patient hence neurosurgical intervention was done in that individual case. The variables were symptoms and signs at presentation, predisposing factors, location of granuloma, involvement of paranasal sinuses, diagnostic studies including blood and urine cultures, septic profile, surgical procedure performed along with histopathology treatment and prognosis. Computed tomography and magnetic resonance imaging scans were performed.

Results: Predominant symptoms included headache (83%) vomiting proptosis (48%) and visual disturbances. Other symptoms were fever, nasal congestion and seizures (18%). Common signs included papilledema with cranial neuropathy I, III, IV, VI and V in patients respectively. Predisposing factors were diabetes and immunocompromise status related to renal dialysis, transplant and tumor. Location was primarily frontal 1 parasellar sellar 1 involvement. One patient underwent frontal craniotomy for resection of fungal granuloma abscess histopathology revealed aspergilloma. All patients treated with itraconazole. Few were offered fluconazole, flucytosine and amphotericin B for a brief period. Mortality 1 secondary to meningoencephalitis.

Conclusion: Early diagnosis, risk versus benefit assessment oriented surgical decompression and prophylactic anti-fungal course according to variability of case with prompt initiation of antifungal therapy showed better outcome. Preoperative oral administration of itraconazole therapy improve clinical outcome in patients with aspergillosis. Larger prospective clinical studies are required to make firm clinical therapeutic recommendations.

Medical therapy with anti-fungal agents is required for prolonged periods following surgery in patients with IFM. In spite of several advances in imaging and surgical techniques and the advent of some newer antifungal agents, the prognosis for patients with IFM continues to remain grim and mortality rates range between 40 and 90% [1].

Keywords: Intracranial Fungal Granuloma (IFG); Antifungal Therapy (AFT); Rhino-orbital Cerebral Mucormycosis (ROCM)


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Citation: Saeed Mazher., et al. “Diagnostic Dilemma of Intracranial Fungal Granuloma Risk Versus Benefit Assessment Before Neurosurgical Management”. EC Neurology 12.11 (2020): 52-60.

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