論文の公開元へトルコ鞍部アスペルギルス膿瘍により両側外転・動眼神経麻痺を呈した１例
概要
An 82-year-old man had suffered from diplopia for1.5 months, and he was referred to our department by an ophthalmologist due to bilateral abducens and oculomotor nerve palsy. Head CT and contrast brain MRI revealed a mass lesion with compression of the pituitary gland and bilateral cavernous sinus at the parasellar region. Bony erosion in the sella turcica and clivus was also confirmed. The serum β-D glucan and aspergillus antigen level were not elevated. The lesion was removed by the endoscopic endonasal approach. Creamy yellow pus and a black necrotic mass were removed. Histopathological examination demonstrated numerous aspergillus hyphae. Voriconazole and prednisolone were given postoperatively. The bilateral abducens and oculomotor nerve palsy gradually improved. Aspergillus sellar abscess is extremely rare and not recognized well among neurosurgeons. However, aspergillus sellar abscess is a life-threatening infection. Systemic antifungal therapy following endoscopic surgical resection in the acute phase is required for improvement of cranial nerve palsy and prevention of intracranial invasion. Preoperative diagnosis of aspergillus abscess in the sellar region is difficult in some cases. We report the clinical features, characteristics of radiological findings and optimal treatment for aspergillus sellar abscess. Shinshu Med J 68 : 209―216, 2020
