gms | German Medical Science

Objective: Intracranial aspergillosis is a very rare disease with high morbidity and mortality rates. This disease is observed most commonly in developing countries and in immunocompromised patients. However, even immunocompetent can contract this disease, making its diagnosis and treatment challenging. We report two cases of intracranial aspergillosis in immunocompetent patients and present special features of this medical condition.

Method: Two patients with mass lesions of the sellar region and clivus on the one hand and a mass lesion in the cavernous sinus and the ethmoid invading the internal carotid artery on the other hand.

Results: Case 1: A 32-year-old male presented with headache since 6-months. His medical history was unremarkable. Cranial MRI revealed destruction of the sellar floor, erosion of the clivus and opacity of the sphenoid sinus. The patient underwent surgery with exploration and extraction of biopsy samples of the lesion via an endoscopic transnasal-transsphenoidal approach. Case 2: A 72-year-old female presented with sudden right-sided vision loss. MRI showed irregular enhancement of the right sphenoid sinus, infiltration of the cavernous sinus and presumable affection of the internal carotid artery that were confirmed on CTA. Resection of the lesion was performed by a ligation of the cervical internal carotid artery followed by microsurgical exploration of the cavernous sinus via a pterional craniotomy. Histopathologic examination revealed the diagnosis of intracranial aspergillosis. Following the microbiological resistogram, voriconazole was administred postoperatively in both cases. After two years of follow-up the headaches in patient 1 improved and follow-up MRI showed reduction of the intracranial mass under continous antimycotic treatment. Patient 2 remained in a stable condition with improved vision of the left eye and decrease in headache under continuous variconazole medication in the short-term follow-up.

Conclusions: Aspergilloma may mimic other tumors due to their mass-like characteristics and intense contrast enhancement on MRI. Aspergillus is angio-invasive because of its ability to digest elastic tissue by producing elastase. Untreated invasive cerebral aspergillosis has a mortality rate of 85-100%. Early diagnosis and prompt treatment in term of resection of the aspergilloma or extraction of biopsy samples, followed by long-term antimycotic drugs are mandatory to obtain clinical improvement and survival of the affected patients.