Cryptococcal infection is the most common fungal infection of the cent
ral nervous system. More than 50 % of the cases of cryptococcal infect
ion are superimposed on an immunosupressive or other general debilatat
ing condition. Cerebral cryptococcosis usually presents as meningitis
or meningoencephalitis, although cerebral granuloma has also been repo
rted. Hydrocephalus is the most common neurosurgical complication of c
erebral cryptococcosis. The majority of patients require only medical
treatment with antifungal drugs. However, when complications ensue, su
rgical intervention is mandatory. We suggest that chronic meningitis b
e ruled out in all patients prior to the placement of shunts. In the t
wo cases reported here treatment of cryptococcal meningitis was a comb
ination of amphotericin B and flucytosine for six weeks. Fluconazole i
s a new alternative and at least as effective as amphotericin B.