INTRACRANIAL MYCOTIC INFECTIONS IN NEUROSURGICAL PRACTICE

Intracranial mycotic infections requiring neurosurgical intervention a re being diagnosed more frequently. This study is a review of 17 cases of intracranial mycotic infections that were treated in a neurosurgic al unit in Saudi Arabia over an 8-year period. A primary focus of infe ction was identified in 41% of patients while 18% of patients had a pr edisposing factor. Forty-seven per cent of patients presented with a b rain abscess (solitary 29%, multiple 18%) while 35% had a granuloma, 1 8% meningitis and ventriculitis and 12% hydrocephalus. The Aspergillus species and Ramichloridium machenziei were the commonest pathogens. F ollowing the appropriate surgical and antimicrobial treatment, the mor tality rate was 41% and there was evidence of residual disease at foll ow-up in 18%. The reason for a fatal outcome was failure to consider a fungal aetiology and to obtain a tissue diagnosis early-because of la te referral (2 cases), as well as failure to respond to antimycotic th erapy (4 cases) and rupture of the internal carotid artery due to Aspe rillus arteritis (one case).It is concluded that an early tissue diagn osis is crucial in the management of intracranial mycotic infection so that the appropriate surgical and antimycotic treatment can be starte d early.