Intracranial aspergillosis mimicking a middle cranial fossa tumor involving the cavernous sinus in an immunocompetent patient: Case report and literature review

Intracranial aspergillosis is rare in immunocompetent patients. Extension to the cranial base via the sphenoid sinus is exceptional. Authors report a case of middle cranial fossa aspergillosis involving the cavernous sinus and mimicking an extra-axial tumor in an immunocompetent 65 year-old male. The patient had been suffering from left trigeminal neuralgia and a horizontal diplopia since 4 months. Physical examination featured a left complete ophtalmoplegia and an hyperesthesia of the left maxillary nerve. Radiological examination showed a left temporal extraaxial temporal expanding intracranial lesion, involving the left cavernous sinus with extension to the sphenoidal sinus. A large tumor resection was performed through a left fronto-temporal craniotomy with no postoperative complications. Pathologic examination and specimen culture concluted to an Aspergillus fumigatus. Authors discuss the clinical, radiological features and management of such lesion through a literature review.