INTRACRANIAL FUNGAL GRANULOMA

BACKGROUND Intracranial fungal granulomas are uncommon and their patho genesis, clinical picture, and effectiveness of therapy remains unclea r. METHODS Thirty-two cases were studied retrospectively in two groups : (1) Rhinocerebral group (22 cases) had a chronic paranasal sinus (PN S) disease with secondary involvement of skull base, cranial nerves, a nd/or brain. The granulomas were adherent to dura, firm, avascular, an d tough, requiring a knife to cut. (2) Primary intracranial group (10 cases) had no detectable PNS lesion at initial presentation. The granu lomas were soft, suckable, and contained pus or necrotic material. RES ULTS Postoperative and overall mortality were 37.5% and 50%, respectiv ely. Meningoencephalitis was the most common cause of death. Altered s ensorium, pus in the granuloma, and/or severe brain edema were poor pr ognostic factors. All survivors except four have symptomatic residual or recurrent lesions. CONCLUSION Early diagnosis with MRI or stereotac tic biopsy, radical surgery, and high dose and chronic suppressive che motherapy may improve overall results in these cases. (C) 1997 by Else vier Science Inc.