Surgical treatment for XXXX in the central nervous system.

@entity1 @entity8 @entity1276 @entity2379 @entity1327 @entity693 @entity281 @entity364 @entity51 @entity302 @entity8662
The hospital records of 78 @entity1 who underwent surgical therapy for @entity364 of the central nervous system (CNS) between 1964 and 1984 are summarized. Nine different fungal types were identified, but @entity8662 and @entity1327 accounted for most (67.1%) of the @entity281 . A variety of clinical syndromes were seen, including chronic @entity693 (45 @entity1 ), intracranial mass lesions (12 @entity1 ), and communicating @entity1276 (six @entity1 ). Thirteen @entity1 had @entity364 , and two presented with spinal involvement. Delays in diagnosis were frequent and ranged from 2 months to 11 years. In 31 @entity1 the CNS lesion was the first indication of a @entity364 , and lesion biopsy or cerebrospinal fluid (CSF) examination confirmed the diagnosis. A total of 144 surgical procedures were carried out, including lesion biopsy or excision in 13 @entity1 , primary CSF shunting in 22, and placement of an Ommaya reservoir for administration of intraventricular or intracisternal antifungal agents in 48. All @entity1 received parenteral and, in some cases, intrathecal or oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 43.6% (34 deaths). With prompt diagnosis and treatment, the mortality rate was 39% whereas, when appropriate treatment was delayed, the mortality rate was 64%. An additional 14 surviving @entity1 (17.9%) exhibited permanent morbidity due to @entity51 , @entity302 , or @entity8 following treatment with @entity2379 . The combined mortality and morbidity rate was 62.8%. Clinical symptoms were resolved completely in 29 @entity1 , although in 10 evidence of disease persisted and chemotherapy was continued. @entity364 of the CNS are being recognized with increased frequency. It is suggested that a high index of suspicion, aggressive attempts to obtain a diagnosis, and early and vigorous therapy may reduce the unfortunate outcome seen in a relatively high proportion of @entity1 with CNS @entity364 .
