Clinical diagnosis and treatment of intracranial fungal infection

Objective To investigate the clinical features, diagnosis and surgical treatment of fungal infection of the central nervous system. Methods In this retrospective study, clinical data including manifestations, imaging, surgical procedure and therapeutic effect of 40 patients who were consecutively diagnosed as intracranial fungal infection from February 2011 to October 2016 at Department of Neurosurgery, Beijing Ditan hospital, Capital Medical University were analyzed. All 40 patients were treated with antifungal treatment. Among them, there were 23 cases with high intracranial pressure caused by Cryptococcus neoformans infection, and shunt operation was performed after failure of lowering intracranial pressure by treatment. There were 17 cases with intracranial occupying lesions, 2 of which underwent stereotactic biopsy and 15 underwent craniotomy. Results Among the 23 patients with high intracranial pressure caused by Cryptococcus neoformans, 21 cases had AIDS (acquired immunodeficiency syndrome) and the other 2 had immunodeficiency due to other diseases. After operation, symptoms related to high intracranial pressure disappeared in 18 cases and were relieved in 5 without spreading of Cryptococcus neoformans infection. At the 6-month follow-up, the patients＇ original symptoms completely disappeared in 19 cases and were improved in 3. In addition, 1 case died of severe pulmonary infection. Among the 17 cases with intracranial lesions, 16 cases had AIDS and 1 case had secondary fungal infection post operation. Two of them underwent stereotactic biopsy and 15 reported good outcomes after craniotomy. None of them developed significant neurological deficits. One patient died from Pseudomonas aeruginosa infection combined with hydrocephalus. Conclusions Fungal infection of the central nervous system fungal mostly occurs in patients with immunodeficiency and is mainly characterized by hydrocephalus or intracranial space occupying lesion. The lesions could be located at the brain parenchyma, skull base and the ventricle system with no specific imaging manifestations. Treatment could be administered by shunting or excision operation and antifungal therapy. Key words: Central nervous system fungal infections; Neurosurgical procedures; Treatment outcome