CRANIAL AND INTRACRANIAL ASPERGILLOSIS OF SINONASAL ORIGIN - REPORT OF 9 CASES

This paper is an attempt at defining the most efficacious surgical and antifungal therapy for invasive cranial and intracranial aspergillosi s, and is based on experience with nine non-immunocompromised patients treated and followed-up by the authors between 1983 and 1994; as well as on the summary of previously reported cases and advances in therap y of this condition. Depending nn the degree of aspergillar involvemen t of the cranial base and intracranial structures, a classification, w ith implications for treatment and prognosis, is also proposed. Two pa tients had extracranial skull base erosion; whereas relentlessly progr essive granulomas, mimicking malignancy, invaded the skull base and in tracranial contents in seven cases. Of these seven patients with crani al and intracranial invasion. Two died of acute intracranial haemorrha ge due to fungal invasion of cerebral blood vessels. In two patients, complete surgical eradication of the disease proved impossible due to cavernous sinus involvement, while residual aspergillomas are still pr esent in orbit and paranasal sinuses (PNS) in a further two patients i n spite of multiples surgical procedures and prolonged antifungal chem otherapy (AFC). What appears to be a cure has been effected in one pat ient only. Multiple therapeutic strategies were used. Biopsy plus syst emic AFC was ineffective, surgical drainage and debridement plus syste mic AFC resulted in long-term survivals but no cure. Radical surgery i n conjunction with systemic and local (intracavitary) AFC should be co nsidered to improve an otherwise poor prognosis.