Of the 21 patients with aspergillosis of central nervrous system seen durin
g the years 1990-1997, 16 (76%) had aspergillosis of sino-cranial origin. T
he occupation in patients with sino-cranial aspergillosis was either agricu
ltural or manual work and predisposing risk factors were present in only tw
o (12.5%) patients. Skull-base syndromes were the presenting features in 13
patients and three patients presented with features of intracranial space-
occupying lesion. Paranasal sinus mass lesions were seen in all the 16 pati
ents. Computerized tomography showed intracranial extradural-enhancing mass
lesions in the anterior, middle or posterior cranial fossa in nine (68%) p
atients, intracranial and orbital lesions in four and orbital lesions in th
ree. Well-formed granuloma with dense fibrosis was the histological feature
. Survival rates were not good even after surgical and antifungal chemother
apy. Surgical treatment was subradical in our series. The majority of cases
of sinocranial aspergillosis are reported from countries with temperate cl
imates and the high incidence in these regions is probably related to const
ant exposure to the high spore content of pathogenic Aspergillus species in
the 'mouldy' work environment.