Management of granulomatous cerebral aspergillosis in immunocompetent adult patients: a review

• Published in: British journal of neurosurgery Vol. 30; no. 3; pp. 280 - 285
• Main Authors: Ellenbogen, Jonathan Richard, Waqar, Mueez, Cooke, Richard P.D., Javadpour, Mohsen
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03-05-2016; Taylor & Francis Ltd
• Subjects: Antifungal agents; Antifungal Agents - therapeutic use; Antimicrobial agents; Aspergillosis - drug therapy; Aspergillosis - immunology; Aspergillosis - surgery; Aspergillus; Central Nervous System - pathology; Central Nervous System - surgery; Disease management; Drug therapy; Fungal infections; Humans; management; Nervous system; Nervous System Diseases - drug therapy; Nervous System Diseases - immunology; Nervous System Diseases - surgery; neuroaspergillosis; Neurological disorders; Postoperative Care; Treatment Outcome; Aspergillus; neuroaspergillosis; management; Antifungal agents
• ISSN: 0268-8697; 1360-046X
• DOI: 10.3109/02688697.2016.1139046

Cerebral aspergillosis, is an infrequent, opportunistic infection of the central nervous system that accounts for 5-10% of all intracranial fungal pathology. It is uncommon in immunocompetent patients and has a significant disease burden, with high morbidity and mortality, even with appropriate treatment. Basic principles of abscess management should be employed, including aspiration and targeted anti-fungal therapy for 12-18 months. However, reported outcomes with a purely minimally invasive approach are poor and there should be a low threshold for surgical excision, especially in resource poor settings and in patients with deteriorating neurology harbouring sizeable masses. Evidence favouring gross total excision over subtotal resection is lacking, however. It is notable that these recommendations are largely based on retrospective case series and isolated case reports. There is a need therefore for international collaboration to evaluate management strategies for immunocompetent patients with cerebral aspergillosis.