An Analysis of 163 Cases of Skull Base Aspergillosis Over 12 Years

Background: Invasive skull base aspergillosis is rarely encountered in neurosurgeon's lifetime. This inflammatory pathology of skull base continues to carry nihilistic approach and management strategy from clinicians, worldwide.

Material and Methods: Since 2001, a total of 163 patients harboring invasive intracranial aspergillosis were managed under neurosurgical services. Age ranged from 6 years to 75 years. During first 5 years majority of patients were administered Amphoterecin B(n = 45), while past 5 years witnessed a dramatic rise of usage of voriconazole(n = 118) as single anti-fungal chemotherapeutic agent in oral formulation. The radiological profile, hallmark features, differential diagnoses were noted. Nasal endoscopy for establishing the diagnosis was used in past 4 years in 68 patients.

Results: Twenty patients of 45 expired after getting Amphoterecin in variable cumulative drug dosages. The outcome improved dramatically after the availability of voriconazole. There were only 5 deaths of 118 patients in voriconazole group. Side-effects like photo-sensitivity were the commonest.

Conclusion: Voriconazole provides better disease control with significantly lower side-effects. Long-term results need to be evaluated at prolonged follow-ups.