一側の視神経障害で発見された頭蓋内アスペルギルス肉芽腫の1例

Intracranial aspergilloma extending into the optic canal

　右眼窩尖端部症候群を呈し，最終的に頭蓋内アスペルギルス肉芽腫と診断された57歳の男性について報告した．

　本症例は頭蓋内アスペルギルス肉芽腫としては視神経管内病変を伴った極めてまれな症例である．全身的には寛解したが右眼は失明した．

　本症例のごとく，視神経障害等以外に他の神経症状を示さずに発症する例のあることから，頭蓋内真菌症は今後，視神経原発腫瘍等との鑑別上留意の必要がある．

A 57-year-old male with a history of suspected pulmonary tuberculosis developed near-total blind-ness in his right eye. The clinical findings were consistent with those of the right orbital apex syn-drome. Computed tomography disclosed an enlarg-ed right optic canal and a small mass in the orbi-tal apex.

We performed craniotomy under the diagnosis of optic nerve tumor. The tumor was found to ex-tend posteriorly along the intracranial portion of the optic nerve. Histopathologically, the tumor mass was found to consist of granulomatous lesions. Hyphae of Aspergillus was identified from the mass.

Dissemination of infection developed after surgery. Infarction of the left frontal-temporal lobe due to vasospasm was identified by computed tomography. The patient recovered eventually after antibiotics treatment leaving right hemiplegia, aphasia, amne-sia and blindness in the right eye.

Aspergillosis involving the central nervous system is resistant to conservative treatment and is often lethal. The possibility of intracranial aspergillosis has to be suspected in the presence of tumor-like lesion of the optic nerve, particularly when there is a history of treatment with antibiotics, corticoste-roids, antineoplastic or immunosupressive agents.