Aspergillus parasellar abscess mimicking radiation-induced neuropathy. Case report.
BACKGROUND
Transsphenoidal surgery is a safe procedure for treatment of pituitary adenomas. However, several complications, including post-surgical infection, are known. We describe a case of Aspergillus parasellar abscess that presented with cranial neuropathies following transsphenoidal surgery and radiosurgery. We initially diagnosed the case as radiation-induced neuropathies, which delayed the detection of Aspergillus.


METHODS
A 55-year-old man underwent transsphenoidal surgery for a pituitary adenoma that presented with pituitary apoplexy. Dexamethasone had been continuously administered for hypocortisolism probably caused by pituitary apoplexy. Four years later, radiosurgery was performed for a relapse in the right cavernous sinus. Another 4 years later, he developed painful right ophthalmoplegia, right ptosis, and bilateral visual impairment, successively. We initially suspected that the painful ophthalmoplegia and ptosis were because of radiation-induced cranial neuropathies; however, results of magnetic resonance (MR) imaging and his clinical course were not consistent with those of radiation-induced neuropathies. Therefore, we performed exploratory surgery that revealed a subdural abscess on the planum sphenoidale. Culture of a specimen grew Aspergillus fumigatus.


CONCLUSIONS
Intracranial fungal abscess is a fatal complication unless it is treated early. It is thus important to consider the possibility of parasellar infection and differentiate it from radiation-induced cranial neuropathies when a patient presents with cranial neuropathies after transsphenoidal surgery and radiosurgery.
Endo
T
T
Department of Neurosurgery, Tohoku University, School of Medicine, Sendai, Japan.
Numagami
Y
Y
Jokura
H
H
Ikeda
H
H
Shirane
R
R
Yoshimoto
T
T
D000038:Abscess / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D000236:Adenoma / Q000601:surgery*; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D003389:Cranial Nerve Diseases / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012658:Sella Turcica / Q000473:pathology* / Q000601:surgery