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Cerebral aspergilloma - a modern case series
EANS Academy. Gempt J. 09/26/19; 276121; EP13012
Dr. Jens Gempt
Dr. Jens Gempt

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Abstract
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Objective: Cerebral aspergillosis is a rare but severe and life threatening condition. Aim of this case series was, to provide a modern cohort of patients with cerebral aspergillosis, assess the clinical characteristics and reveal the relevant aspects for future therapy for such a condition.
Methods: In a 10 years period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients' and disease characteristics were recorded, including age, mortality, dates and types of surgical procedures, neurological symptoms and length and type of antifungal treatment, Germ spectrum, and immunosuppressive conditions were also assessed.
Results: The mean age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 2.6 surgeries per patient followed by antifungal treatment for 6 months (=median) according to the microbiological findings. Regarding comorbidities, mean CCI at the time of admission was 6, representing an estimated 10-year survival of 2%. Six of 10 patients (60%) showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. 4 patients showed associated frontobasal bone destruction, mycotic aneurysms or thromboses. Mean duration of hospital stay was 37 days. Mortality was still very high. 80% of the patients died during the follow-up period. Within the three immunocompetent patients, 2 died from aspergillosis during hospital stay.
Conclusion: Cerebral aspergillosis is a rare, but still life threatening condition, which predominantly occurs in immunosuppressive conditions. Despite radical surgical removal of infected tissue and antifungal therapy for several months, mortality is surprisingly high.
Objective: Cerebral aspergillosis is a rare but severe and life threatening condition. Aim of this case series was, to provide a modern cohort of patients with cerebral aspergillosis, assess the clinical characteristics and reveal the relevant aspects for future therapy for such a condition.
Methods: In a 10 years period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients' and disease characteristics were recorded, including age, mortality, dates and types of surgical procedures, neurological symptoms and length and type of antifungal treatment, Germ spectrum, and immunosuppressive conditions were also assessed.
Results: The mean age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 2.6 surgeries per patient followed by antifungal treatment for 6 months (=median) according to the microbiological findings. Regarding comorbidities, mean CCI at the time of admission was 6, representing an estimated 10-year survival of 2%. Six of 10 patients (60%) showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. 4 patients showed associated frontobasal bone destruction, mycotic aneurysms or thromboses. Mean duration of hospital stay was 37 days. Mortality was still very high. 80% of the patients died during the follow-up period. Within the three immunocompetent patients, 2 died from aspergillosis during hospital stay.
Conclusion: Cerebral aspergillosis is a rare, but still life threatening condition, which predominantly occurs in immunosuppressive conditions. Despite radical surgical removal of infected tissue and antifungal therapy for several months, mortality is surprisingly high.
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