Cerebral aspergillosis after evacuation of a chronic subdural hematoma via a single burr – hole: a case report and review of the literature

Abstract

Abstract Introduction/objective and importance Postoperative aspergillosis of the Central Nervous System (CNS) constitutes a rare complication following neurosurgical intervention, with a mortality rate that exceeds 70%. Herein, we report a case of postoperative cerebral aspergillosis (CA) following drainage of a left frontotemporal chronic subdural hematoma (CSDH). Clinical presentation A male patient was treated with a single burr-hole drainage for a left frontotemporal CSDH in our institution. One year later he presented with a 10-day history of wound discharge and speech difficulties. A head CT scan revealed left subdural empyema. Intervention He underwent an emergent left frontotemporoparietal craniectomy and evacuation of the empyema. Pus cultures were positive for Aspergillus fumigatus , and the patient received antifungal therapy; initially with Voriconazole and afterwards with Isavuconazole, for six weeks. Three months after the craniectomy, the patient underwent a cranioplasty procedure. During his follow-up examination 1.5 years after the craniectomy, he remains fit and well with no signs of residual disease. Conclusion Review of the world literature revealed 25 previously reported postoperative CNS aspergillosis cases. The clinical features, radiologic and laboratory diagnosis, treatment options and prognosis for this rare entity are summarized. Early diagnosis followed by combined surgical and antifungal management are important for improving the clinical outcome.