A Case of Severe Bilateral Abducens and Oculomotor Nerve Palsy Caused by Aspergillus Sellar Abscess / 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
- Resource Type
- Journal Article
- Authors
- Atsushi Sato; Kazuhiro HONGO; Keisuke KAMIYA; Tetsuo SASAKI; Toshihiro OGIWARA; 佐々木 哲郎; 佐藤 篤; 本郷 一博; 神谷 圭祐; 荻原 利浩
- Source
- 信州医学雑誌 / THE SHINSHU MEDICAL JOURNAL. 2020, 68(4):209
- Subject
- abducens nerve palsy
aspergillus
oculomotor nerve palsy
sellar abscess
アスペルギルス
トルコ鞍部膿瘍
動眼神経麻痺
外転神経麻痺
- Language
- Japanese
- ISSN
- 0037-3826
1884-6580
An 82-year-old man had suffered from diplopia for 1.5 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.