Aspergillus parasellar abscess mimicking radiation-induced neuropathy - Case report

BACKGROUND Transsphenoidal surgery is a safe procedure for treatment of pit uitary adenomas. However, several complications, including post-surgical in fection, are known. We describe a case of Aspergillus parasellar abscess th at presented with cranial neuropathies following transsphenoidal surgery an d radiosurgery. We initially diagnosed the case as radiation-induced neurop athies, which delayed the detection of Aspergillus. CASE DESCRIPTION A 55-year-old man underwent transsphenoidal surgery for a pituitary adenoma that presented with pituitary apoplexy. Dexamethasone had been continuously administered for hypocortisolism probably caused by pitu itary apoplexy. Four years later, radiosurgery was performed for a relapse in the right cavernous sinus. Another 4 years later, he developed painful r ight ophthalmoplegia, right ptosis, and bilateral visual impairment, succes sively. We initially suspected that the painful ophthalmoplegia and ptosis were because of radiation-induced cranial neuropathies; however, results of magnetic resonance (MR) imaging and his clinical course were not consisten t with those of radiation-induced neuropathies. Therefore, we performed exp loratory surgery that revealed a subdural abscess on the planum sphenoidale . Culture of a specimen grew Aspergillus fumigatus. CONCLUSION Intracranial fungal abscess is a fatal complication unless it is treated early. It is thus important to consider the possibility of parasel lar infection and differentiate it from radiation-induced cranial neuropath ies when a patient presents with cranial neuropathies after transsphenoidal surgery and radiosurgery. (C) 2001 by Elsevier Science Inc.