Surgical and Medical Treatment Impact on Survival Among Cerebral Aspergillosis

• Published in: Neurosurgery Vol. 67; no. Supplement_1
• Main Authors: Pajer, Hengameh B, Asher, Anthony, Gelinne, Aaron, Northam, Wes, van Duin, David, Quinsey, Carolyn
• Format: Journal Article
• Language: English
• Published: Philadelphia Wolters Kluwer Health, Inc 01-12-2020
• Subjects: Antifungal agents; Aspergillosis; Fungal infections; Neurosurgery; Patients; Surgical techniques
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa447_493

INTRODUCTION Cerebral aspergillosis carries a high mortality rate. Rapid diagnosis and treatment can increase rates of survival, but in most cases, symptoms and imaging findings are nonspecific. The combination of voriconazole and surgical resection has improved outcomes, however, the literature on cerebral aspergillosis consists mostly of case report and case series, lacking large scale review of data. METHODS We performed a systematic review of the literature on cerebral aspergillosis using PubMed in March 2019. Articles reporting cerebral aspergillosis that incorporated treatment course of patient including specific antifungal treatment and surgical intervention, and outcome of the patient were identified. we recorded the year of publication, age and sex of patients, neurosurgical involvement, the antifungals administered, use of intrathecal antifungals, and the outcome of the patient. The relationships between variables were tested using bivariant statics and linear regression. RESULTS A total of 324 studies met the eligibility criteria, and 199 studies including 248 patients were included. Surgical resection (P < .01) and administration of voriconazole (P < .001) or itraconazole (P < .001) were all shown to be independent predictors of survival. Patient age, sex, intrathecal antifungals, and cumulative number of antifungals used did not predict survival. CONCLUSION Given the significant survival benefits for patients who received voriconazole and surgical intervention, we suggest early antifungal medical treatment and resection.