Intra cranial Cryptococcoma - Clinicopathological correlation and surgical outcome-a single institute experience.

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Intra cranial Cryptococcoma - Clinicopathological correlation and surgical outcome-a single institute experience.

World Neurosurg. 2018 Apr 17;:

Authors: Uppar A, Raj ARP, Konar S, K S, Shukla D, Somanna S, Devi BI, C Y, Chandrashekar N

Abstract
OBJECTIVE: The present case series describes the clinical characteristics of patients diagnosed with intra cranialcryptococcoma(ICC), the clinic-pathological correlation and the outcomes following surgery.
MATERIALS AND METHODS: The clinical data were collected from hospital case records and pathological confirmation was done by a neuropathologist. Clinical details, imaging features, and treatment modalities were studied and were correlated with outcomes based on regular follow up.
RESULTS: We had five cases of histology and culture-provenICC.Three of them(60%) were between 3rd to 5th decades of life.Three were supratentorial in location and two were in the posterior fossa. One patient presented with seizures. Fever was a presenting complaint in three cases (60%). Three patients had papilledema (60%) and four had signs of meningeal irritation (80%). Four cases (80%) were immunocompetent. Only one patient was immunocompromised.All lesions were peripherally enhancing on computed tomography scan.Four of our five cases underwent surgical decompression without any residue. Only one patient underwent stereotactic biopsy. All cases received antifungal therapy. One patient who was immunocompromised developed multi-organ failure and died after 2 months following surgery (20%).We had a good outcome in four out of five (80%) cases with a mean follow up to 5 years.
CONCLUSIONS: Cryptococcus gattii is a rarer species implicated in ICC which is seen along with the commoner C.neoformans. Early diagnosis and surgical decompression followed by IV AMB therapy for at least 6 weeks and concomitant therapy with fluconazole for prolonged periods may reduce morbidity and mortality.

PMID: 29678697 [PubMed - as supplied by publisher]

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