Aspergillus sphenoiditis growth on long cut ends of a non-absorbable sellar floor dura closure suture

Abstract

Background: Cerebrospinal fluid (CSF) rhinorrhea is a common complication after transsphenoidal surgery (TSS). Suturing of sellar dura is effective in the prevention of postoperative CSF rhinorrhea, but it may cause rare postoperative infections. Herein, we report a case of Aspergillus sphenoiditis with the growth noted on cut ends of a polyvinylidene fluoride (PVDF) suture used for dural closure. Case Description: A previously healthy 51-year-old woman complained of abnormal odor 5 years after TSS for null cell adenoma. A white mass in the sphenoidal sinus was detected on rhinoscopy. Fungal balls were found clustered around the ends of a PVDF suture used for dural closure at the initial surgery. She underwent removal of both the fungal ball and dural suture. The pathological diagnosis was Aspergillus hyphae. It is thought that a dural suture protruding out of the sphenoid sinus mucosa can cause Aspergillus infection even in immunocompetent patients. A rapid and accurate diagnosis followed by surgical removal of the fungal ball and follow-up with oral antimycotic drugs result in good clinical outcomes. Conclusion: It is crucial to cut short the suture end and cover it with sphenoid sinus mucosa to avoid such complications.

Intracranial aspergilloma mimicking metachronous meningioma following transsphenoidal removal of a tuberculum sellae meningioma: illustrative case

“…Post-eTSS CNS aspergillosis infection has been reported infrequently, usually presenting as a mycotic aneurysm subsequent to vasculitis or a local fungus ball formation. [7][8][9] Here, we describe a case of CNS aspergilloma that developed over 6 months following eTSS for a tuberculum sellae meningioma in an immunocompetent patient who had concurrent asymptomatic fungal sinusitis at the time of the initial eTSS.…”