Advertisement

Cranial Vault Lesions

  • Ali Akhaddar
Chapter

Abstract

Cranial fungal infection is a rare disease. Often located in the skull base, few cases of cranial vault involvement have been reported in fungal infections. The calvaria may be involved by various fungal pathogens, mostly from Aspergillus species. The infection has a spectrum of presenting features, and most patients are immunocompromised hosts, although immunocompetent subjects can also be affected. Usually patients presented a chronic soft exophytic mass with skin tenderness. Neuroimaging data are usually indicative of osteomyelitis but are not specific for cranial vault mycosis. However, the most significant finding for diagnosis should be made by histopathological examination and culture of specimens obtained at surgery. Fungal cranial vault infections are usually misdiagnosed and frequently considered only following failure of antibacterial therapy resulting in high rate of morbidity and intracranial complications. Systemic antifungal medications with or without surgery remain the cornerstone of management. High index of suspicion, early diagnosis, and aggressive surgical management if needed, followed by antifungal drugs, by an interdisciplinary team, may help to improve outcomes.

Keywords

Aspergillosis Cranial osteomyelitis Cranial vault Cryptococcosis Fungal infections Mycosis Osteitis Scalp abscess 

Abbreviation

CVM

Cranial vault mycosis

References

  1. Agadi JB, Madni NA, Nanjappa V, Govindaiah HK. Cryptococcal osteomyelitis of the skull in a patient with transient lymphopenia. Neurol India. 2010;58(2):300–2.  https://doi.org/10.4103/0028-3886.63798.CrossRefPubMedGoogle Scholar
  2. Akhaddar A. Cranial osteomyelitis. Diagnosis and treatment. 1st ed. Switzerland: Springer International Publishing; 2016.  https://doi.org/10.1007/978-3-319-30268-3.CrossRefGoogle Scholar
  3. Akhaddar A. Cranial osteomyelitis. In: Atlas of infections in neurosurgery and spinal surgery. 1st ed. Switzerland: Springer International Publishing; 2017a. p. 33–42.  https://doi.org/10.1007/978-3-319-60086-4_4.CrossRefGoogle Scholar
  4. Akhaddar A. Fungal infections of the central nervous system. In: Atlas of infections in neurosurgery and spinal surgery. 1st ed. Switzerland: Springer International Publishing; 2017b. p. 317–3.  https://doi.org/10.1007/978-3-319-60086-4_29.CrossRefGoogle Scholar
  5. Amit A, Sudish K, Pople IK. Primary calvarial cryptococcal osteomyelitis in a patient with idiopathic lymphopenia. Acta Neurochir (Wien). 2008;150(7):713–4.  https://doi.org/10.1007/s00701-008-1608-8.CrossRefGoogle Scholar
  6. Antony SJ, Parikh MS, Friedman G. Coccidioidomycosis involving the cranium: a case report and review of current literature. Infect Disord Drug Targets. 2015;15(3):202–6.CrossRefGoogle Scholar
  7. Arnold MG, Arnold JC, Bloom DC, Brewster DF, Thiringer JK. Head and neck manifestations of disseminated coccidioidomycosis. Laryngoscope. 2004;114(4):747–52.CrossRefGoogle Scholar
  8. Baddley JW, Cobbs CS, Pappas PG. Surgical treatment of multiple skull abscesses associated with coccidioidomycosis. Mycoses. 2004;47(1–2):69–71.CrossRefGoogle Scholar
  9. Beeram V, Challa S, Vannemreddy P. Cerebral mycetoma with cranial osteomyelitis. J Neurosurg Pediatr. 2008;1(6):493–5.  https://doi.org/10.3171/PED/2008/1/6/493.CrossRefPubMedGoogle Scholar
  10. Blyth CC, Gomes L, Sorrell TC, da Cruz M, Sud A, Chen SC. Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 2011;17(2):306–11.  https://doi.org/10.1111/j.1469-0691.2010.03231.x.CrossRefPubMedGoogle Scholar
  11. Corral JE, Lima S, Quezada J, Samayoa B, Arathoon E. Cryptococcal osteomyelitis of the skull. Med Mycol. 2011;49:667–71.  https://doi.org/10.3109/13693786.2011.558124.CrossRefPubMedGoogle Scholar
  12. Effat KG, Karam M, El-Kabani A. Pott’s puffy tumour caused by mucormycosis. J Laryngol Otol. 2005;119(8):643–5.CrossRefGoogle Scholar
  13. Fernández-Guerrero ML, Ruiz Barnés P, Alés JM. Postcraniotomy mycetoma of the scalp and osteomyelitis due to Pseudallescheria boydii. J Infect Dis. 1987;156(5):855.CrossRefGoogle Scholar
  14. Fortún J, Cobo J, Cañal J, Martínez-San Millán J. Post-traumatic cranial mucormycosis in an immunocompetent patient. J Oral Maxillofac Surg. 1995;53(9):1099–102.CrossRefGoogle Scholar
  15. Gamaletsou MN, Rammaert B, Bueno MA, Moriyama B, Sipsas NV, Kontoyiannis DP, et al. Aspergillus osteomyelitis: epidemiology, clinical manifestations, management, and outcome. J Infect. 2014;68(5):478–93.  https://doi.org/10.1016/j.jinf.2013.12.008.CrossRefPubMedGoogle Scholar
  16. Goel RS, Kataria R, Sinha VD, Gupta A, Singh S, Jain A. Craniocerebral maduromycosis. J Neurosurg Pediatr. 2012;10(1):67–70.  https://doi.org/10.3171/2012.3.PEDS1252.CrossRefPubMedGoogle Scholar
  17. Hickey BB. Cranial maduromycosis. Trans R Soc Trop Med Hyg. 1950;50:393–6.CrossRefGoogle Scholar
  18. Honeybul S, Morrison DA. Skull vault destruction after rhinocerebral mucormycosis. World Neurosurg. 2012;78(5):553.e1–4.  https://doi.org/10.1016/j.wneu.2011.12.009.CrossRefGoogle Scholar
  19. Kong QT, Zhou WQ, Feng J, Sang H, Deng DQ, Wang Z, et al. Isolated skull cryptococcosis in an immunocompetent patient. Mycopathologia. 2013;175(1–2):187–91.  https://doi.org/10.1007/s11046-012-9609-9.CrossRefPubMedGoogle Scholar
  20. Letscher V, Herbrecht R, Gaudias J, Taglang G, Koenig H, Dupuis MG, et al. Post-traumatic intracranial epidural Aspergillus fumigatus abscess. J Med Vet Mycol. 1997;35(4):279–82.CrossRefGoogle Scholar
  21. Mateev G, Kantardjiev T, Vassileva S, Tsankov N. Chronic mucocutaneous candidosis with osteolysis of the frontal bone. Int J Dermatol. 1993;32(12):888–9.CrossRefGoogle Scholar
  22. Naim-Ur-Rahman, Abdullah AK, Hawass NE, Sadiq S, el-Nageeb S, Akhtar-Uz-Zaman. Cranial and epidural mycetoma caused by streptomyces somaliensis. Neuroradiology. 1987;29(1):95–7.CrossRefGoogle Scholar
  23. Panda NK, Ekambar Eshwara Reddy C. Primary frontal sinus aspergillosis: an uncommon occurrence. Mycoses. 2005;48(4):235–7.CrossRefGoogle Scholar
  24. Patel SA, Chatterjee A, Simonsen K. Recurrent midline frontal mass in a patient with sinusitis. Clin Pediatr (Phila). 2011;50(3):266–8.  https://doi.org/10.1177/0009922809352680.CrossRefGoogle Scholar
  25. Pudipeddi AV, Liu K, Watson GF, Davis RJ, Strasser SI. Cryptococcal osteomyelitis of the skull in a liver transplant patient. Transpl Infect Dis. 2016;18(6):954–6.  https://doi.org/10.1111/tid.12602.CrossRefPubMedGoogle Scholar
  26. Qiu Y, Zhang J, Liu G, Zhong X, Deng J, He Z, et al. Retrospective analysis of 14 cases of disseminated Penicillium marneffei infection with osteolytic lesions. BMC Infect Dis. 2015;15:47.  https://doi.org/10.1186/s12879-015-0782-6.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Reining JW, Hungerford GD, Mohrmann ME, Vera CL. Case report 268. Skelet Radiol. 1984;11:221–3.CrossRefGoogle Scholar
  28. Rerolle JP, Szelag JC, Diaconita M, Paraf F, Aldigier JC, Le Meur Y. Intracranial granuloma and skull osteolysis: complication of a primary cutaneous cryptococcosis in a kidney transplant recipient. Am J Kidney Dis. 2005;46(6):e113–7.CrossRefGoogle Scholar
  29. Rodríguez-Hernández MJ, Jiménez-Mejías ME, Montero JM, Regordan C, Ferreras G. Aspergillus fumigatus cranial infection after accidental traumatism. Eur J Clin Microbiol Infect Dis. 2001;20(9):655–6.CrossRefGoogle Scholar
  30. Rootjes PA, Rozemeijer W, Dutilh JC. A patient with sarcoidosis and a cryptococcal infection of the skull. Med J Aust. 2016;204(9):353.CrossRefGoogle Scholar
  31. Rosanova MT, Voto C, Carnovale S, Tramonti N, Lema J, Pinheiro JL, et al. Osteomyelitis in burn children: ten years of experience. Arch Argent Pediatr. 2018;116(1):59–61.  https://doi.org/10.5546/aap.2018.eng.59.CrossRefPubMedGoogle Scholar
  32. Taj-Aldeen SJ, Gamaletsou MN, Rammaert B, Sipsas NV, Zeller V, Roilides E, et al. Bone and joint infections caused by mucormycetes: a challenging osteoarticular mycosis of the twenty-first century. Med Mycol. 2017;55(7):691–704.  https://doi.org/10.1093/mmy/myw136.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Wolkow N, Jakobiec FA, Stagner AM, Cunnane ME, Piantadosi AL, Basgoz N, et al. Chronic orbital and calvarial fungal infection with Apophysomyces variabilis in an immunocompetent patient. Surv Ophthalmol. 2017;62(1):70–82.  https://doi.org/10.1016/j.survophthal.2016.05.006.CrossRefPubMedGoogle Scholar
  34. Wood L, Miedzinski L. Skeletal cryptococcosis: case report and review of the literature. Can J Infect Dis. 1996;7(2):125–32.CrossRefGoogle Scholar
  35. Wright M, Fikrig S, Haller JO. Aspergillosis in children with acquired immune deficiency. Pediatr Radiol. 1993;23(6):492–4.CrossRefGoogle Scholar
  36. Yocum J, Seligson D. Blastomycosis of the knee and skull after arthroscopy. Am J Sports Med. 1991;19(6):670–2.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ali Akhaddar
    • 1
  1. 1.Department of Neurosurgery, Avicenne Military Hospital of MarrakechMohammed V University of RabatRabatMorocco

Personalised recommendations