ABSTRACT
BACKGROUND: This is a case of lateral recess stenosis secondary occurred the discal fungus infection treated with percutaneous transforaminal endoscopic discectomy (PTED). There has been no relevant reports before. CASE PRESENTATION: A 49-year-old patient who had taken itraconazole for 13 months for lateral recess stenosis secondary occurred the discal fungus infection complained of gradually worsening radiating pain and numbness in the back and inguinal and inner thigh region of right side. In order to relieve the radiating neuralgia and reduce the damage to spinal stability, the minimally invasive PTED was performed.The patient's prognosis was assessed using Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). During the follow-up, the patient's ODI and VAS scores were decreased significantly. The radiating pain in the inguinal and inner thigh region of right side were significantly alleviated and the discomfort caused by lower back instability was improved by plaster vest. DISCUSSION AND CONCLUSION: PTED not only avoids further damage to the stability of the lumbar spine, but also effectively relieves the symptoms of leg neuroradialgia caused by lateral recess stenosis secondary occurred the discal fungus infection.
Subject(s)
Aspergillus flavus , Diskectomy, Percutaneous/methods , Intervertebral Disc/surgery , Neuroaspergillosis/surgery , Neuroendoscopy/methods , Spinal Stenosis/surgery , Aspergillus flavus/isolation & purification , Humans , Intervertebral Disc/diagnostic imaging , Intervertebral Disc/microbiology , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/microbiology , Lumbar Vertebrae/surgery , Male , Middle Aged , Neuroaspergillosis/diagnostic imaging , Spinal Stenosis/diagnostic imaging , Spinal Stenosis/microbiology , Treatment OutcomeABSTRACT
Aspergillosis is a disease that predominantly affects immunocompromised patients. The incidence in immunocompetents is rare, and manifestation is generally pulmonary. Few reports in the literature refer to isolated cerebral aspergillosis in individuals with no chronic comorbidities. We describe a case of a 59-year-old rural worker without previous pathologies who had a partial convulsive crisis in a subtle form, with self-limiting and nonrecurrent secondary generalization. Diagnostic investigation demonstrated a subcortical tumorlike lesion in the right precentral gyrus by nuclear magnetic resonance that allowed en bloc microsurgical resection, with histopathologic findings indicating cerebral aspergillosis. Because of the delay in obtaining the result of the biopsy due to technical difficulties with analysis, the diagnosis was delayed. The patient was clinically stable, with imaging without modifications and with negative serologic tests, so it was decided to follow the patient without antifungal therapy, which was successful. This was a case of isolated cerebral aspergillosis in an immunocompetent individual who was successfully treated by complete resection of the lesion alone, without combined antifungal therapy.
Subject(s)
Brain Diseases/surgery , Frontal Lobe/surgery , Neuroaspergillosis/surgery , Neurosurgical Procedures/methods , Brain Diseases/diagnostic imaging , Frontal Lobe/diagnostic imaging , Humans , Magnetic Resonance Spectroscopy , Male , Middle Aged , Neuroaspergillosis/diagnostic imaging , Treatment OutcomeSubject(s)
Immunocompetence/immunology , Neuroaspergillosis/diagnosis , Neuroaspergillosis/immunology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/immunology , Sphenoid Sinusitis/diagnosis , Sphenoid Sinusitis/immunology , Craniotomy , Diagnosis, Differential , Disease Progression , Fatal Outcome , Female , Follow-Up Studies , Humans , Hyperbaric Oxygenation , Magnetic Resonance Imaging , Microsurgery , Middle Aged , Neuroaspergillosis/surgery , Optic Nerve Diseases/surgery , Postoperative Complications/diagnosis , Postoperative Complications/immunology , Recurrence , Reoperation , Sphenoid Sinusitis/surgery , Tomography, X-Ray Computed , Voriconazole/therapeutic useABSTRACT
Cerebral Aspergillosis is the most lethal manifestation of infection due to Aspergillus species arising most commonly as hematogenous dissemination from a pulmonary focus, direct extension from paranasal sinus infection or direct inoculation through trauma and surgery of the central nervous system (CNS). Voriconazole is currently considered the standard of treatment of CNS aspergillosis with liposomal amphotericin B being the next best alternative. Neurosurgical resection of infected cerebral tissue in addition to antifungal therapy is frequently performed in patients with CNS aspergillosis to prevent neurological deficits and improve outcome. Aspergillus endophthalmitis may occur endogenously mostly from a pulmonary focus or exogenously following eye surgery or trauma. Although amphotericin B is still described as the primary therapy, voriconazole is increasingly considered the first line treatment of Aspergillus endophthalmitis. Vitrectomy is recommended in most cases of Aspergillus endophthalmitis.
Subject(s)
Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Neuroaspergillosis/drug therapy , Amphotericin B/therapeutic use , Animals , Aspergillosis/microbiology , Aspergillosis/surgery , Aspergillus/isolation & purification , Combined Modality Therapy , Endophthalmitis/drug therapy , Endophthalmitis/microbiology , Endophthalmitis/surgery , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Eye Infections, Fungal/surgery , Humans , Neuroaspergillosis/microbiology , Neuroaspergillosis/surgery , Pyrimidines/therapeutic use , Triazoles/therapeutic use , Vitrectomy/methods , VoriconazoleABSTRACT
Invasive craniocerebral aspergillosis, often encountered in an immunocompromised setting, is almost uniformly fatal despite radical surgical and medical management, and is frequently a necropsy finding. The authors report a unique, self-resolving clinical course of this aggressive infection in a 10-month-old infant. The infant was brought to the emergency services in altered sensorium with a 1-week history of left-sided hemiparesis, excessive irritability, and vomiting. An MRI study of the brain revealed multiple, heterogeneously enhancing lesions in the right cerebral hemisphere with mass effect. The largest lesion in the frontotemporal cortical and subcortical regions was decompressed on an emergent basis. Histopathological findings were suggestive of invasive aspergillosis, although there was no evidence of the infection in the lungs or paranasal sinuses. Computed tomography-guided aspiration of the remaining lesions and follow-up antifungal therapy were recommended. The parents, however, requested discharge without further treatment. The child was seen at a follow-up visit 3 years later without having received any antifungal treatment. Imaging showed resolution of the infection and features of Dyke-Davidoff-Masson syndrome (cerebral hemiatrophy). This report of invasive cerebral aspergillosis resolving without medical therapy is the first of its kind. Its clinicoradiological aspects are discussed in light of previously reported cases.
Subject(s)
Brain Abscess/microbiology , Brain Abscess/surgery , Decompressive Craniectomy , Immunocompetence , Neuroaspergillosis/surgery , Remission, Spontaneous , Brain Abscess/diagnosis , Brain Abscess/physiopathology , Humans , Infant , Magnetic Resonance Imaging , Male , Neuroaspergillosis/diagnosis , Neuroaspergillosis/physiopathology , Suppuration , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Aspergillus fumigatus/isolation & purification , Hydrocephalus/etiology , Neuroaspergillosis/complications , Antifungal Agents/therapeutic use , Cerebrospinal Fluid Shunts , Colitis, Ulcerative/complications , Colitis, Ulcerative/drug therapy , Combined Modality Therapy , Drainage , Fatal Outcome , Fungemia/etiology , Fungemia/microbiology , Humans , Hydrocephalus/microbiology , Hydrocephalus/surgery , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Intracranial Embolism/etiology , Invasive Pulmonary Aspergillosis/complications , Invasive Pulmonary Aspergillosis/drug therapy , Male , Middle Aged , Neuroaspergillosis/diagnosis , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Prednisone/adverse effects , Prednisone/therapeutic useABSTRACT
During the last five decades, long-term therapy with immunosuppressive agents such as pulse cyclophosphamide in conjunction with high-dose corticosteroids has enhanced both patient survival and renal survival in patients with diffuse proliferative lupus nephritis. Nevertheless, severe side effects such as infectious complications remain the main cause of morbidity and mortality. Central nervous system aspergillosis is uncommon but life-threatening in lupus patients. In this single-patient case study, carotid aneurysm with sphenoidal sinusitis was suspected when severe epistaxis occurred during cyclophosphamide pulse therapy. With anti-fungal therapy, a graft stent was successfully deployed to the aneurysm and specimens of sphenoidal mucosa showed typical hyphae, indicating aspergillosis. Three months after stopping voriconazole treatment, two cerebral aneurysms that were revealed on MR images were successfully removed by aneurysmal clipping. The patient remained alive at one-year follow-up with lupus nephritis in remission. The rarity and high mortality of aspergillus-related fungal aneurysms have led to most cases being recognized postmortem. However, such aneurysms must be diagnosed early to prevent fatal complications by performing appropriate management such as surgical procedure or endovascular intervention.
Subject(s)
Intracranial Aneurysm/etiology , Lupus Nephritis/complications , Neuroaspergillosis/etiology , Antifungal Agents/therapeutic use , Female , Humans , Immunosuppressive Agents/adverse effects , Intracranial Aneurysm/drug therapy , Intracranial Aneurysm/surgery , Lupus Nephritis/drug therapy , Middle Aged , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Pyrimidines/therapeutic use , Stents , Surgical Instruments , Triazoles/therapeutic use , VoriconazoleABSTRACT
Fungal infections of the central nervous system (CNS) are uncommon and occur mainly in immunocompromised patients. We describe a case of central nervous system aspergilloma without any evidence of systemic or paranasal foci in a diabetic but otherwise immunocompetent 71-year-old female treated successfully with surgical resection and medical therapy with voriconazole. Magnetic resonance imaging (MRI) after 6 months of voriconazole showed improvement and no evidence of residual or recurrent disease. Given its good CNS penetration, voriconazole along with surgical resection appears to be promising in treatment of these infections. Our case also demonstrates the importance of surgical intervention in the diagnosis and management of these atypical cases.
Subject(s)
Antifungal Agents/administration & dosage , Neuroaspergillosis/drug therapy , Pyrimidines/administration & dosage , Temporal Lobe/microbiology , Temporal Lobe/pathology , Triazoles/administration & dosage , Aged , Diabetes Complications/microbiology , Diabetes Complications/pathology , Diabetes Complications/surgery , Diabetes Mellitus, Type 2/complications , Female , Humans , Immunocompetence/physiology , Neuroaspergillosis/pathology , Neuroaspergillosis/surgery , Neurosurgical Procedures/methods , Temporal Lobe/surgery , Treatment Outcome , VoriconazoleABSTRACT
Aspergillus sp. is a fungus that is very common in nature and may cause invasive disease with high mortality, especially in immunosuppressed patients. Here we present a case of central nervous system (CNS) aspergillosis in a previously healthy immunocompetent patient. A 23-year-old female was admitted to hospital with the complaints of headache, blurred vision, and double vision. In her cranial magnetic resonance imaging, abscess and paranchymal edema were observed in the left frontal lobe, and biopsy was performed with endoscopic nasal operation. The pathology result was consistent with aspergillus infection. It should be remembered that although CNS aspergillosis generally occurs in immunosuppressed patients, it may also rarely be diagnosed in immunocompetent individuals.
Subject(s)
Aspergillus/isolation & purification , Neuroaspergillosis/diagnosis , Neuroaspergillosis/pathology , Adult , Biopsy , Brain Abscess/diagnosis , Brain Abscess/pathology , Brain Abscess/surgery , Brain Edema/diagnosis , Brain Edema/pathology , Brain Edema/surgery , Central Nervous System/pathology , Central Nervous System/surgery , Endoscopy , Female , Frontal Lobe/pathology , Frontal Lobe/surgery , Head/diagnostic imaging , Humans , Magnetic Resonance Imaging , Neuroaspergillosis/surgery , Radiography , Young AdultABSTRACT
Invasive spinal aspergillosis in an immunocompetent child is rare and often there is a considerable delay in diagnosis. A 13-year-old male child treated medically as tuberculosis of spine elsewhere for 1 year, came with complete paraplegia, dorsolumbar kyphosis and intermittently discharging sinus in the back. The child was taken up for surgical decompression and stabilization. Intraoperatively black granulomatous material was noted inside the canal extending anteriorly towards the vertebral body. There was complete cord transection with severe vertebral destruction and osteoporosis. The pathology and microbiology confirmed aspergillosis and the child was started on antifungal treatment. At further follow up, the infection was found to spread to the lung and caused further vertebral destruction. A change in the antifungal medication controlled further spread but failed to eradicate the infection at 2-year follow-up. In this patient, the delay led to extensive vertebral destruction with spine deformity and spontaneous cord transection. Retrospective review of the clinical and radiological findings suggests that this complication could have been prevented if these findings were carefully interpreted. In this era of transplantation and increase in use of immunosuppressive drugs the authors suggests having fungal infection as a differential diagnosis for infections of the spine.
Subject(s)
Aspergillus fumigatus , Neuroaspergillosis/diagnosis , Spondylitis/microbiology , Tuberculosis, Spinal/diagnosis , Adolescent , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Decompression, Surgical , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Spine/surgery , Spondylitis/drug therapy , Spondylitis/surgery , Treatment Outcome , Tuberculosis, Spinal/drug therapy , Tuberculosis, Spinal/surgeryABSTRACT
Invasive aspergillosis has long been recognized as one of the most significant and often fatal opportunistic fungal infections in liver transplant recipients. We report a case of a liver transplant recipient who developed an Aspergillus fumigatus brain abscess that produced significant neurologic symptoms. The patient was managed successfully with a combination of surgery and medical treatment with Voriconazole. To our knowledge, this is the second such case reported in the literature.
Subject(s)
Aspergillus fumigatus/isolation & purification , Brain Abscess/drug therapy , Brain Abscess/surgery , Liver Transplantation/adverse effects , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Antifungal Agents/administration & dosage , Aspergillus fumigatus/drug effects , Brain Abscess/microbiology , Drainage , Female , Humans , Immunocompromised Host , Middle Aged , Neuroaspergillosis/microbiology , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Opportunistic Infections/surgery , Pyrimidines/administration & dosage , Transplantation , Triazoles/administration & dosage , VoriconazoleABSTRACT
A sellar aspergillus abscess is a rare fungal infection of the central nervous system (CNS). A retrospective analysis of three patients with sellar aspergillus abscess was conducted from 2006 to 2008. Data were retrieved from patient records at our hospital. Clinical findings, pathological data and final outcomes were reviewed and analysed. All patients underwent transsphenoidal surgery with the operating microscope and histopathologic examination revealed aspergillosis in all cases. Postoperatively, all patients received medical treatment with voriconazole and caspofungin. During the 3-6-month follow-up period, the patients were symptom free with no recurrences. Therefore, sellar aspergillus abscess should be included in the differential diagnosis of a sellar mass. Early and correct diagnosis via surgery can improve the prognosis. A combination of surgical resection and antifungal therapy has a good outcome. The importance of early treatment for sellar aspergillus abscesses is emphasised.
Subject(s)
Brain Abscess/drug therapy , Brain Abscess/surgery , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Pituitary Diseases/drug therapy , Pituitary Diseases/surgery , Aged , Antifungal Agents/therapeutic use , Brain Abscess/microbiology , Caspofungin , Diagnosis, Differential , Echinocandins/therapeutic use , Female , Humans , Lipopeptides , Male , Middle Aged , Neuroaspergillosis/pathology , Neurosurgical Procedures , Pituitary Diseases/microbiology , Pituitary Neoplasms/pathology , Pyrimidines/therapeutic use , Triazoles/therapeutic use , VoriconazoleABSTRACT
Intracranial aspergillosis of the lateral ventricle is a rare condition and has not been reported in a schizophrenic patient. We report a 39-year-old male patient with underlying schizophrenia and a rapid deterioration of consciousness. Initial cranial computed tomographic images revealed focal dilatation of the posterior part of the right lateral ventricle with a severe mass effect and midline shift. The patient received an emergency endoscopic ventriculostomy, and the resected mass was proven to be aspergillus. The patient was postoperatively treated by prolonged external ventricular drainage and antifungal medication, with no recurrence of aspergillosis at the 12-month follow-up.
Subject(s)
Neuroaspergillosis/surgery , Adult , Antifungal Agents/therapeutic use , Combined Modality Therapy , Drainage , Endoscopy , Humans , Male , Neuroaspergillosis/drug therapy , Schizophrenia/complications , Tomography, X-Ray Computed , VentriculostomyABSTRACT
Aspergillus infection of the central nervous system is a rare disease, occasionally seen among immunocompromised patients. The most frequent pathway is hematogenic dissemination. Less known is the direct propagation from the paranasal sinuses, which is usually observed in immunocompetent patients. We report a patient who developed cavernous sinus syndrome due to an invasive intracranial aspergilloma after longlasting chemo- and steroid therapy for chronic lymphoid leukemia and immunhemolytic anemia. The characteristic features seen on radiological images--brain CT and MRI--suggested the possibility of invasive aspergilloma. Postoperative histology defined the diagnosis. Our case review highlights the importance of considering the possibility of an invasive opportunistic infection of the CNS in an immunocompromised patient presenting a new neurological sign.
Subject(s)
Cavernous Sinus , Immunocompromised Host , Neuroaspergillosis/diagnostic imaging , Neuroaspergillosis/pathology , Aged , Cavernous Sinus/parasitology , Humans , Magnetic Resonance Angiography , Male , Neuroaspergillosis/surgery , Syndrome , Tomography, X-Ray ComputedABSTRACT
Craniocerebral aspergillosis is a rare but dangerous central nervous system infection. The infection has a spectrum of presenting features, mostly affecting immunocompromised individuals. The incidence appears to be on the rise that has been especially observed in the immunocompetent population. A high index of suspicion, a comprehensive understanding of the infectious process and advanced laboratory and radiological diagnostic techniques, allow early diagnosis. Surgery, followed by systemic antifungal medications, remains the cornerstone of management. Early administration of empirical anti-fungal agents along with immunomodulators may further improve prognosis. Immunocompetent patients tend to have better outcomes as compared to those who are immunocompromised. Patients with intradural disease carry the worst prognosis.
Subject(s)
Brain Diseases/microbiology , Neuroaspergillosis/diagnosis , Neuroaspergillosis/surgery , Animals , Antifungal Agents/administration & dosage , Humans , Immunocompetence , Immunocompromised Host , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Neuroaspergillosis/drug therapy , Skull Base/microbiology , Tomography, X-Ray ComputedABSTRACT
Cerebral aspergillosis is a rare condition that generally exhibits a poor response to conventional antifungal drugs. We report here a case of cerebral aspergillosis in a 34-years-old man with acute lymphoblastic leukaemia who was successfully treated with a combination of aggressive neurosurgery, intracavitary instillation of amphotericin B and voriconazole. We aimed to emphazise the roles of surgery, intracavitary therapy and antifungal therapy in the management of neuroaspergillosis. Under amphotericin-B therapy, the patient developed dysarthria and paralysis of the right side of his body. Brain magnetic resonance imaging demonstrated a lesion in the left parieto-occipital region, measuring 7 cm in the greatest dimension. Diagnostic surgery was interrupted due to abundant bleeding. The culture of the aspirate from the lesion yielded Aspergillus flavus. The therapy was switched to voriconazole and caspofungin combination. Due to disease progression during combination therapy, the patient had a second surgical resection resulting in a 75% reduction in lesion size. Following surgical intervention, intracavitary instillation of amphotericin B (0.3 mg/day for 15 days) was performed alongside with combination therapy (voriconazole and caspofungin). Caspofungin was stopped after 42 days, whereas the patient was continued on voriconazole for a total of 100 days. At this point, his brain lesion resolved almost completely. However, leukemia relapsed. The patient died during his treatment course because of neutropenic typhilitis occurring in the aplastic phase. It is stated that in patients with neuroaspergillosis radical neurosurgery leads to better outcomes if performed at an earlier stage. Antifungal treatment of cerebral aspergillosis requires that the drug must cross the blood brain barrier. Voriconazole has the ability to cross the blood brain barrier. The therapy should be prolonged beyond the resolution of all lesions and until reversal of the underlying predisposition. We conclude that the use of neurosurgery and voriconazole together appears to be a reliable and effective treatment modality in patients with cerebral aspergillosis.
Subject(s)
Antifungal Agents/therapeutic use , Aspergillus flavus/isolation & purification , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Adult , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/administration & dosage , Aspergillus flavus/drug effects , Caspofungin , Chemotherapy, Adjuvant , Drug Therapy, Combination , Echinocandins/administration & dosage , Echinocandins/therapeutic use , Fatal Outcome , Humans , Injections, Intraventricular , Lipopeptides , Male , Pyrimidines/administration & dosage , Pyrimidines/therapeutic use , Triazoles/administration & dosage , Triazoles/therapeutic use , VoriconazoleABSTRACT
Aspergillosis of the sphenoid sinus is rare in immunocompetent patients. It may be mistaken for a sellar region tumor. A 65-year-old, human immunodeficiency virus-negative man presented with a 3-week history of cranial nerve III paresis and visual deterioration. The patient had a long-term history of tobacco snuff abuse. CT scans and MRI demonstrated a space-occupying lesion of the sellar and sphenoid sinus region. Presumptive diagnosis of pituitary macroadenoma was made and the patient was operated on via a transnasal-transsphenoidal approach. After the sphenoid sinus was opened, a yellow-brownish gluey material with crumbly debris extruded and was aspirated. The dura was intact. Histopathology revealed numerous Aspergillus hyphae without tissue invasion. Postoperatively, the cranial nerve III paresis resolved in a few days and visual acuity improved. Sphenoid sinus aspergillosis should be included in the differential diagnosis of sellar region processes, even in immunocompetent patients. Early diagnosis and transsphenoidal removal provides good results without the need for systemic antifungal therapy in non-invasive aspergillosis.
Subject(s)
Neuroaspergillosis/pathology , Pituitary Neoplasms/diagnosis , Sphenoid Sinus/microbiology , Sphenoid Sinus/pathology , Sphenoid Sinusitis/microbiology , Sphenoid Sinusitis/pathology , Aged , Aspergillus , Calcinosis/diagnostic imaging , Calcinosis/microbiology , Calcinosis/pathology , Diagnosis, Differential , Humans , Immunocompetence , Magnetic Resonance Imaging , Male , Neuroaspergillosis/diagnostic imaging , Neuroaspergillosis/surgery , Oculomotor Nerve Diseases/etiology , Otorhinolaryngologic Surgical Procedures , Sella Turcica/diagnostic imaging , Sella Turcica/microbiology , Sella Turcica/pathology , Sphenoid Sinus/diagnostic imaging , Sphenoid Sinusitis/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Vision, Low/etiologyABSTRACT
In HIV-infected patients, central nervous system (CNS) aspergillosis is rare. Historically, the outcome of such infections has been almost invariably fatal. We report a case involving an AIDS patient with an Aspergillus fumigatus brain abscess who survived for longer than 10 months after surgical drainage and therapy with voriconazole.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Aspergillus fumigatus/isolation & purification , Neuroaspergillosis/diagnosis , Adult , Antifungal Agents/therapeutic use , Brain/pathology , Head/diagnostic imaging , Humans , Male , Neuroaspergillosis/drug therapy , Neuroaspergillosis/surgery , Pyrimidines/therapeutic use , Radiography , Survival , Time Factors , Treatment Outcome , Triazoles/therapeutic use , VoriconazoleABSTRACT
INTRODUCTION: Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients with a high mortality. Surgical excision of the intracranial lesion combined with oral voriconazole has been proposed to improve the outcome in immunocompromised patients. Itraconazole has been considered not to be effective because of poor penetration into the brain tissue. We report the long-term outcome of 3 cases of intracranial aspergilloma in immunocompetent patients who were successfully treated with radical surgery combined with oral itraconazole. MATERIALS AND METHODS: This is a retrospective study in which chronic invasive intracranial aspergilloma was successfully treated in 3 apparently immunocompetent patients and followed-up for more than 5 years. RESULTS: Near complete or radical surgical removal of this localised chronic invasive intracranial aspergilloma whenever possible is the definitive treatment. When combined with the oral antifungal drug itraconazole, the management regimen is effective in achieving near complete long-term cure of more than 5 years. Oral itraconazole 200 mg twice daily should be given for a prolonged period of at least 6 months. CONCLUSION: In chronic invasive intracranial aspergilloma in an immunocompetent patient, it was suggested that radical excision of the intracranial aspergilloma combined with oral antifungal drug belonging to triazole group that can be either itraconazole or voriconazole given for a period of 6 months was likely to improve the long-term outcome.