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[Skull base aspergillosis granuloma originating from the sphenoid sinus: a case report]
1Department of Neurosurgery, Toyama Medical and Pharmaceutical University.
Abstract:
A case of skull base Aspergillus granuloma originating from the sphenoid sinus was reported. This 64-year-old man complained of unilateral visual loss and serious facial pain, and was admitted to our department. He had been treated by transnasal sphenoidectomy because of sphenoid sinus aspergillosis. MRI showed a mass lesion located in the sphenoid sinus, cavernous sinus, ethmoid sinus and intraorbit. Angiography showed severe stenosis of the left internal carotid artery at the cavernous portion. As the symptoms gradually aggravated, we felt compelled to perform intracranial surgical treatment using the extradural approach to the skull base lesions. As the fibrous lesion was very hard and strongly adherent to the surrounding tissues, only partial removal of the lesion and resection of the trigeninal nerve were carried out. After surgery, the patient was released from severe facial pain and had an uneventful course. But, two months later, he died due to Aspergillus meningoencephalitis. Aspergillosis originating from the sphenoid sinus is rare, but it is known that some lesions show abrupt invasive extension to the skull base and the prognosis is bad. Early diagnosis and suitable treatment for the skull base or intracranial lesions is required.
Insights
Skull base Aspergillus granuloma, originating in the sphenoid sinus, can aggressively invade surrounding structures. Early diagnosis and treatment are crucial for this rare but dangerous fungal infection.
Area of Science:
- Neurology
- Otolaryngology
- Infectious Diseases
Background:
- Skull base Aspergillus granuloma is a rare fungal infection.
- Sphenoid sinus aspergillosis can lead to invasive extension.
Observation:
- A 64-year-old man presented with unilateral visual loss and facial pain due to sphenoid sinus aspergillosis.
- MRI revealed a mass involving the sphenoid sinus, cavernous sinus, ethmoid sinus, and orbit.
- Angiography showed severe stenosis of the left internal carotid artery.
Findings:
- Surgical debulking of the hard, adherent granuloma was performed via an extradural approach.
- Partial removal of the lesion and trigeminal nerve resection were necessary.
- Post-operatively, facial pain improved, but the patient later developed Aspergillus meningoencephalitis.
Implications:
- This case highlights the potential for rapid, invasive spread of Aspergillus from the sphenoid sinus to the skull base and intracranial structures.
- Aggressive fungal infections of the skull base carry a poor prognosis.
- Emphasizes the need for prompt diagnosis and comprehensive management of skull base and intracranial fungal lesions.