海綿静脈洞部アスペルギルス症の1例

A Case of Cavernous Sinus Aspergillosis

Ⅰ．はじめに

　アスペルギルス症は免疫不全患者に発症することが多く，予後不良な疾患である^2,11)．さらに中枢神経系においては，脳血管への侵襲により脳血管障害を合併することも多い^8,13)．われわれは，副鼻腔炎からの浸潤によると考えられる海綿静脈洞部アスペルギルス症を経験した．内頚動脈閉塞を伴ったが脳梗塞は起こさず，外科的にbiopsyを行い，早期の診断治療により良好な経過が得られたので，文献的考察を加えて報告する．

　We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.