颅内真菌性肉芽肿。
Intracranial fungal granuloma.
作者信息
Sharma B S, Khosla V K, Kak V K, Banerjee A K, Vasishtha R K, Prasad K S, Sharma S C, Mathuriya S N, Tewari M K, Pathak A
机构信息
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Surg Neurol. 1997 May;47(5):489-97. doi: 10.1016/s0090-3019(96)00209-1.
BACKGROUND
Intracranial fungal granulomas are uncommon and their pathogenesis, clinical picture, and effectiveness of therapy remains unclear.
METHODS
Thirty-two cases were studied retrospectively in two groups: (1) Rhinocerebral group (22 cases) had a chronic paranasal sinus (PNS) disease with secondary involvement of skull base, cranial nerves, and/or brain. The granulomas were adherent to dura, firm, avascular, and tough, requiring a knife to cut. (2) Primary intracranial group (10 cases) had no detectable PNS lesion at initial presentation. The granulomas were soft, suckable, and contained pus or necrotic material.
RESULTS
Postoperative and overall mortality were 37.5% and 50%, respectively. Meningoencephalitis was the most common cause of death. Altered sensorium, pus in the granuloma, and/or severe brain edema were poor prognostic factors. All survivors except four have symptomatic residual or recurrent lesions.
CONCLUSION
Early diagnosis with MRI or stereotactic biopsy, radical surgery, and high dose and chronic suppressive chemotherapy may improve overall results in these cases.
背景
颅内真菌性肉芽肿并不常见，其发病机制、临床表现及治疗效果仍不明确。
方法
回顾性研究32例患者，分为两组：（1）鼻脑组（22例），患有慢性鼻旁窦（PNS）疾病，继发累及颅底、颅神经和/或脑。肉芽肿附着于硬脑膜，质地坚硬，无血管，坚韧，需用刀切割。（2）原发性颅内组（10例），初诊时未发现PNS病变。肉芽肿质地柔软，可吸出，含有脓液或坏死物质。
结果
术后死亡率和总死亡率分别为37.5%和50%。脑膜脑炎是最常见的死亡原因。意识改变、肉芽肿内有脓液和/或严重脑水肿是不良预后因素。除4例幸存者外，其余均有症状性残留或复发病变。
结论
早期通过MRI或立体定向活检诊断、根治性手术以及高剂量和长期抑制性化疗可能改善这些病例的总体治疗效果。
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