Surgical Managment of Intracranial Invasive Aspergillosis in Immunocompetent Patients: Results From 3 Case Reports - Surgical Managment of Intracranial Invasive Aspergillosis in Immunocompetent Patients: Results From 3 Case Reports - Open Access Pub

Cerebral aspergillosis is a severe disease most commonly suspected in immunodeficient patients. The objective of this study is to determine the role of surgery in management of intracranial aspergillosis. We report three cases of immunocompetent patients presenting: posteriror fossa aspergillosis, sphenoidal extended to sellar region aspergillosis and post operative aspergillosis without extracerebral involvement. Microbiology and histological examination were carried out to provide the diagnosis. The patients underwent surgical procedure associated with medical treatment or not. In one case, surgical treatment was efficient. The outcome was good in two cases. Conclusion: Rapid diagnosis of invasive aspergillosis applying radiological and surgical procedures and immediate ignition of antifungal can be life saving. Rapid diagnosis of invasive aspergillosis applying radiological and surgical procedures and immediate ignition of antifungal can be life saving. DOI 10.14302/issn.2470-5020.jnrt-16-1288 Cerebral aspergillosis is severe parasitic disease which is rare in immunocompetent individual. The invasive form with multiple visual involvements is usually seen with immunosuppression. New therapeutic agents such as voriconazole and capsofungine which are more save and efficacious have changed the outcome of this fatale cerebral infection. A 47 year old patient with no previous medical history presented with features of raised intracranial pressure, statokinetic cerebellar syndrome as well as left sided hemiparesis. The diagnosis of posterior fossa space occupying lesion was made. Neuroradiologic investigations demonstrated posterior fossa lesions. Magnetic resonance imaging and spectroscopy were in favor of a multiple infective process (Figure 1). Stereotatic biopsy was carried out on the patient and parasitological and histological examinations of the specimen concluded to a filamentous fungal infection of Aspergillus type. Culture and staining techniques categorized the specie as Aspergillus fumigatus (Figure 2). Figure 1. cerebral MRI axial T1-weighted (A) and coronale (B), showing a multiples well circumscribed posterior fossa lesions Figure 2. ( A) filamentous fungal infection of Aspergillus type. (B) Culture and staining techniques categorized the specie as Aspergillus fumigatus Patient was placed on intra veinous amphotéricin B but this was complicated with acute active hydrocephalus warranting external ventricular drainage (Figure 3). Subsequently, he developped staphylococcal meningitis as day 8 post op, treated with intra veinous vancomycin.