• Ilya Leyngold, Alessandro Olivi, Masaru Ishii, Ari Blitz, Peter Burger, Prem S Subramanian, and Gary Gallia.
• Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: ileyngo1@health.usf.edu.
• World Neurosurg. 2014 Jan 1;81(1):203.e1-6.

ObjectiveIntracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient.Case DescriptionA 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess.ResultsThe patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient's life and vision were preserved.ConclusionsThe case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.Copyright © 2014 Elsevier Inc. All rights reserved.

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