颅内真菌性肉芽肿(IFG)仍然是一个罕见的实体。作者报告了一项90例IFG的单研究所研究,这是迄今为止最大的研究。
在这项回顾性研究中,纳入了2001-2018年手术治疗的所有IFG病例.数据来自病历和病理学,微生物学,和放射科.所有相关临床数据,成像特性,进行的外科手术,围手术期发现,并从病例档案中记录随访数据.还对一些患者进行了电话随访,以了解他们的现状。
共评估90例,其中男性64例(71.1%),女性26例(28.9%)。患者平均年龄为40.2岁(范围1-79岁)。头痛(54名患者)是最常见的主诉,其次是视觉症状(35例),发烧(21名患者),和其他如肢体无力(13例)或癫痫发作(9例)。颅内神经受累是最常见的体征(47例),其次是运动障碍(22例)和乳头水肿(7例)。出现前症状的平均持续时间为6.4个月(范围0.06-48个月)。30例患者(33.3%)有糖尿病等诱发因素,结核病,或其他免疫受损状态。在49例(54.4%)中发现了IFG的纯颅内位置,而鼻脑或鼻旁窦受累41例(45.6%)。开腹手术,也就是说,开颅减压术,在55例病例中进行了手术,30例进行了内镜活检,5例进行了立体定向活检。曲霉菌瘤(43例)是最常见的真菌肿块,其次是合子菌病(13例),色瘤病(9例),隐球菌(7例),毛霉菌病(5例),和念珠菌感染(1例)。在12个案例中,无法确定确切的真菌表型。69/90例患者(76.7%)获得随访。平均随访时间为37.97个月(范围3-144个月)。在有随访的患者中,死亡率为52.2%(36/69例)。
对于免疫功能低下的患者和患有鼻脑肿块病变的糖尿病患者,应该存在对IFG的高度怀疑指数。早期诊断,积极的手术减压,及时开始抗真菌治疗的疗程与更好的预后相关。
Intracranial fungal granuloma (IFG) remains an uncommon entity. The authors report a single-institute study of 90 cases of IFG, which is the largest study until now.
In this retrospective study, all cases of IFG surgically treated in the years 2001-2018 were included. Data were obtained from the medical records and the pathology, microbiology, and radiology departments. All relevant clinical data, imaging characteristics, surgical procedure performed, perioperative findings, and follow-up data were recorded from the case files. Telephonic follow-up was also performed for a few patients to find out their current status.
A total of 90 cases consisting of 64 males (71.1%) and 26 (28.9%) females were evaluated. The mean patient age was 40.2 years (range 1-79 years). Headache (54 patients) was the most common presenting complaint, followed by visual symptoms (35 patients), fever (21 patients), and others such as limb weakness (13 patients) or seizure (9 patients). Cranial nerve involvement was the most common sign (47 patients), followed by motor deficit (22 patients) and papilledema (7 patients). The mean duration of symptoms before presentation was 6.4 months (range 0.06-48 months). Thirty patients (33.3%) had predisposing factors like diabetes mellitus, tuberculosis, or other immunocompromised status. A pure intracranial location of the IFG was seen in 49 cases (54.4%), whereas rhinocerebral or paranasal sinus involvement was seen in 41 cases (45.6%). Open surgery, that is, craniotomy and decompression, was performed in 55 cases, endoscopic biopsy was done in 30 cases, and stereotactic biopsy was performed in 5 cases. Aspergilloma (43 patients) was the most common fungal mass, followed by zygomycosis (13 patients), chromomycosis (9 patients), cryptococcoma (7 patients), mucormycosis (5 patients), and candida infection (1 patient). In 12 cases, the exact fungal phenotype could not be identified. Follow-up was available for 69/90 patients (76.7%). The mean duration of the follow-up was 37.97 months (range 3-144 months). The mortality rate was 52.2% (36/69 patients) among the patients with available follow-up.
A high index of suspicion for IFG should exist for patients with an immunocompromised status and diabetic patients with rhinocerebral mass lesions. Early diagnosis, aggressive surgical decompression, and a course of promptly initiated antifungal therapy are associated with a better prognosis.