頭蓋内進展を伴ったアスペルギルス性眼窩先端部症候群の2例

Two cases of orbital apex syndrome caused by aspergillosis with intracranial invasion

79歳男性が慢性副鼻腔炎に対して手術を受け，アスペルギルス塊を同定された。糖尿病の既往があった。術後約1か月から左顔面痛が生じ，光覚消失，眼瞼下垂，全方向への眼球運動障害が生じた。磁気共鳴画像検査（MRI）で病変が眼窩先端部にまで浸潤していた。90歳女性が半年前からの頭痛と左眼視力低下で受診した。左眼に光覚消失，眼瞼下垂，全方向への眼球運動障害があった。MRIで左蝶形骨洞に占拠性病変があり，手術でアスペルギルス塊が同定され可及的完全に除去した。両症例とも抗真菌薬を全身投与したが，病変が頭蓋内に進展し死の転帰をとった。アスペルギルスによる眼窩先端部症候群は予後が不良であり，早期診断と治療が望まれる。

A 79-year-old male received surgery for chronic sinusitis. He was diagnosed with aspergillosis. He had poorly controlled diabetes mellitus. One month after surgery,he developed left facial pain,loss of vision in his left eye,eyelid ptosis,and restriction of ocular motility in all directions. Magnetic resonance imaging（MRI）showed infiltration of lesion reaching the orbital apex. Another 90-year-old female presented with headache and loss of vision in her left eye. She had also ptosis,and restriction of ocular motility in all directions. MRI showed space-occupying lesion in the left sphenoidal sinus. Surgery led to the diagnosis of aspergillosis. Both cases were treated by antifungal agents. Intracranial spread of infection resulted in fatal outcome. These cases illustrate that orbital apex syndrome due to aspergillosis need early detection and treatment because of poor prognosis.