title: [Case of invasive sino-orbital aspergillosis developing orbital apex syndrome].
abstract: Sino-orbital invasive aspergillosis has been regarded as a lethal disease. The authors report a case with a successful treatment result. A 65 year-old woman, with mild diabetes mellitus, presented progressive right visual disturbance, diplopia, ptosis, and severe periorbital pain over a period of 2 weeks. MR images with gadolinium contrast showed a heterogeneously enhanced mass extending from the right orbital apex to the cavernous sinus. Despite steroid pulse therapy, her symptoms progressed. An open biopsy revealed invasive sino-orbital aspergillosis. Intravenous and oral antifungal agents were administered, but the aspergilloma gradually expanded. Her general status deteriorated due to intractable periorbital pain that was resistant to narcotic analgesics. By a craniotomy, the aspergilloma involving the orbit and cavernous sinus was radically removed leaving the internal carotid artery intact and simultaneously rhizotomy of the trigeminal nerve was carried out. The postoperative course was uneventful and the pain was remarkably ameliorated. Three years after the surgery, she has been well, receiving voriconazole and experiencing no relapse of the disease.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, 15-7 Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Yuuta
authors.initials: Y
authors.lastname: Kamoshima
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sawamura
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Hamada
authors.forename: Naoto
authors.initials: N
authors.lastname: Izumi
authors.forename: Shu
authors.initials: S
authors.lastname: Okugawa
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000150:complications* / Q000628:therapy*; D002426:Cavernous Sinus / Q000601:surgery; D003389:Cranial Nerve Diseases / Q000209:etiology*; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D009915:Orbit / Q000601:surgery; D009916:Orbital Diseases / Q000150:complications* / Q000628:therapy*; D013517:Otorhinolaryngologic Surgical Procedures; D010254:Paranasal Sinus Diseases / Q000150:complications* / Q000628:therapy*; D011743:Pyrimidines / Q000008:administration & dosage; D013577:Syndrome; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage; D014786:Vision Disorders / Q000209:etiology*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole