Improving Outcomes in Cerebral Aspergillosis

Abstract

solated intracerebral aspergillosis without a focus of disease in the sinuses or the lungs and in the absence of immunoI compromise due to disease or medications is extremely rare. A confirmatory absence of systemic aspergillosis can be obtained using computed tomography or magnetic resonance imaging (MRI), both of which are significantly more sensitive than conventional x-rays for detecting infection in either the sinuses or the lungs. Because of the uncommon occurrence of this infection in healthy individuals, most articles represent case reports demonstrating a successful clinical outcome after a combination of surgical and medical management. In the current issue of WORLD NEUROSURGERY is one of the few series that contains several patients that were identified over a 15-year interval. The clinical course of central nervous system (CNS) aspergillosis is distinctly different in immunocompetent patients when compared to their immunosuppressed counterparts. The clinical course for a patient with CNS aspergillosis is much more benign when an intact immune system is present with recoveries being uneventful in contrast to the horrific experience endured by those with immune compromise. In addition, the survival rates for the immunocompetent patients without systemic involvement are in the range of 80%e90% in contrast to the 5%e30% rates that are often seen in immunocompromised patients.