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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
09:53

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Published on: July 5, 2021

Meningotheliomatous meningioma accompanied by aspergillosis at the skull base

T Sameshima1, Y Morita, M Yanagita

  • 1Department of Neurosurgery, Miyazaki Medical College, Kiyotake, Japan.

Brain Tumor Pathology
|May 18, 1999
PubMed

Insights

This case highlights a rare instance of fungal infection mimicking a brain tumor. Aspergillosis can present similarly to meningioma on MRI, emphasizing the need for careful diagnosis in skull base lesions.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Skull base lesions can present with varied symptoms, including headache and visual disturbances.
  • Meningiomas are common primary tumors in this region, often diagnosed via Magnetic Resonance Imaging (MRI).
  • Corticosteroid treatment for presumed inflammatory conditions can sometimes mask underlying infections.

Observation:

  • A 73-year-old male presented with chronic headache and vision loss, initially treated for optic neuritis.
  • MRI revealed a tuberculum sellae lesion with imaging characteristics suggestive of meningioma.
  • Intraoperative findings showed purulent inflammation, leading to biopsy and subsequent diagnosis of aspergillosis coexisting with meningioma.

Findings:

  • Histopathological examination confirmed the presence of aspergillosis within a meningotheliomatous meningioma.
  • The imaging features of meningioma and intracranial aspergillosis can be indistinguishable on MRI.
  • Despite antifungal treatment, the patient succumbed to meningoencephalitis approximately one month post-surgery.

Implications:

  • This case underscores the importance of considering fungal infections, specifically aspergillosis, in the differential diagnosis of skull base masses.
  • The presence of sinusitis, particularly sphenoid sinusitis, should raise suspicion for fungal etiology in meningioma-like lesions.
  • Accurate preoperative diagnosis is crucial for appropriate management and improved patient outcomes in complex skull base pathologies.

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