Aspergillus sellar abscess: Case report and review of the literature.

Aspergillus sellar abscess is a very rare form of fungal infections of the central nervous system (CNS). In this report, we describe the successful treatment of a patient with aspergillus sellar abscess. A 65-year-old woman presented with headache, nasal discharge and decreased visual acuity. The diagnosis of sellar mass was made on the basis of magnetic resonance imaging (MRI) examination. The computed tomography (CT) scan revealed sellar enlargement and sellar floor bony destruction. After hospitalization the patient underwent transsphenoidal surgery. Histopathological examination of the sellar mass revealed aspergillosis. Postoperatively, amphotericine-B and itraconazole therapy was started. During a six-month follow-up, the patient's headache and inertia disappeared, visual acuity improved. Aspergillus sellar abscess must be considered in the differential diagnosis of a sellar mass. The correct diagnosis of pituitary aspergillosis can only be achieved by histopathological examination. Surgical intervention and antifungal therapy should be considered the optimal treatment.

Microsurgical management of giant meningiomas / 中国微创外科杂志

Objective To study the effects and techniques of microsurgical resection of giant hypervascular meningiomas. Methods A retrospective analysis was performed on clinical data of 32 cases of giant hypervascular meningiomas in this hospital from June 1999 to June 2002. Results The Simpson Grade 1 resection was achieved in 15 cases, Grade 2 in 9 cases, Grade 3 in 6 cases, and Grade 4, 2 cases. There were 2 fatal cases. Complications included 4 cases of intracranial hematoma, 6 cases of cerebral edema and infarction (re-operation of decompression was required in 4 cases), 1 case of mutism, 3 cases of cerebrospinal fluid leakage, and 1 case of intracranial infection. The mental dysfunctions or symptoms became worse than before the operation in 7 cases. Follow-up checkups in 30 patients found no recurrence in Simpson Grade 1 resection, 4 cases of recurrence in Simpson Grade 2 resection, and 5 cases of recurrence in Grade 3 and 4. A re-operation was performed to remove the tumor in 6 cases. The size of tumor was unchanged during follow-up period in 7 cases undergoing radiotherapy. Postoperatively, assessments with activity of daily living (ADL) associated with mental dysfunctions revealed grade Ⅰ in 25 cases, grade Ⅱ in 5 cases, and grade Ⅲ in 2. No significant differences were seen in ADL assessments before and after operation (P=0.696). Conclusions Every effort should be made to complete the total resection of intracranial meningiomas. Sufficient preoperative preparation, adequate surgical exposure, efficient management of operative bleeding, and fractionated resection of tumor using microsurgical techniques are important factors to improve clinical outcomes.