Endoscopic transorbital approach for resection of Meckel's cave aspergillosis: illustrative case

Aspergillosis involving Meckel's cave (MC) is rare. Only 5 previous case reports exist in the literature. The primary treatment for this disease is surgical debridement combined with antifungal therapy. The authors present a minimally invasive technique using an endoscopic transorbital approach (ETOA) to manage this condition.

A 26-year-old male corn farmer presented with progressive right-sided facial pain and numbness for 1 month. MRI demonstrated a markedly hypointense T2 signal lesion in the right MC with gadolinium enhancement. CT revealed sphenoid sinus opacification with bony erosion. Nasal endoscopy with sphenoidotomy and mucosal biopsy were noncontributory. He underwent an ETOA via lateral canthotomy. Irregular yellowish rubbery tissue adherent to all divisions of the trigeminal nerve was resected. Histopathological analysis confirmed septate fungal hyphae. The fungal culture identified Aspergillus flavus. After 6 months of voriconazole, the facial pain resolved despite persistent numbness, and MRI demonstrated radiological resolution of the lesion. The patient remained free of recurrence at 1 year.

MC aspergillosis can present as trigeminal neuropathy in immunocompetent patients. The ETOA provides direct extradural access permitting tissue diagnosis and debridement without temporal lobe retraction. Combined with antifungal therapy, this approach may be a feasible strategy for this disease. https://thejns.org/doi/10.3171/CASE26736.