Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
Acta Neurochir (Wien). 2010 Jan;152(1):129-36. doi: 10.1007/s00701-009-0311-8. Epub 2009 Apr 30.
Cryptococcal infection in CNS is frequently seen in HIV patients and those with other immunosuppressed conditions. However, cryptococcal granuloma in CNS in immunocompetent patient is rare. We present one new case of cryptococcoma and review literature to illustrate diagnosis and treatment of these lesions.
We conducted literature search in Pubmed search engine of the National Center for Biotechnology Information.
Seventeen cases of CNS cryptoccoma in immunocompetent patients, including ours, have been reported to date. Of them, two patients had lesions inside spinal cord, and C. neoformans var. gattii was identified in three cases. All patients were symptomatic with normal immunocompetency although two patients had type 2 diabetes mellitus and one had torsades de pointes. Eight patients received surgical treatment and all were given antifungal agents except one suspected of teniasis.
With literature reports and our experiences, we suggest that ring shaped enhancement of mass lesion with or without cystic changes in MR scan may indicate cryptococcoma, but definitive diagnosis relies on pathology study of lesion specimen. Open surgery and anti-fungal therapy should be scheduled, and outcome of cryptococcoma is largely determined by its locations.
中枢神经系统（CNS）的隐球菌感染常见于 HIV 患者和其他免疫抑制患者，但免疫功能正常患者的 CNS 隐球菌肉芽肿则较为少见。我们报告了 1 例新型隐球菌肿，并对文献进行了回顾，以阐明这些病变的诊断和治疗。
我们在国家生物技术信息中心的 Pubmed 搜索引擎中进行了文献检索。
迄今为止，共报道了 17 例免疫功能正常患者的 CNS 隐球菌肿，包括我们的病例。其中 2 例患者脊髓内有病变，3 例患者鉴定出新型隐球菌变种 gattii。所有患者均有症状，但免疫功能正常，尽管有 2 例患者患有 2 型糖尿病，1 例患者有心尖端扭转型室速。8 例患者接受了手术治疗，除了 1 例疑似绦虫病患者外，所有患者均接受了抗真菌治疗。
根据文献报告和我们的经验，我们建议磁共振成像（MRI）上肿块的环形强化伴或不伴囊性改变可能提示隐球菌肿，但明确诊断依赖于病变标本的病理研究。应进行开放性手术和抗真菌治疗，隐球菌肿的预后在很大程度上取决于其位置。
