Interdisciplinary Neurosurgery · Published 2026-07-16 · DOI 10.1016/j.inat.2026.102325
Meng-Lian Duan, Yi-Chen Li, Hui-Ying Yan, Zhi-Feng Zhang, Ning Han, Peng-Lai Zhao, Rong Wang
Background: Intracranial aspergillosis carries a mortality rate of >80%. We present a multimodal approach combining staged surgical debridement, metagenomic next-generation sequencing (mNGS), therapeutic drug monitoring (TDM), and intracavitary echinocandin therapy. Case Description: A 59-year-old immunocompetent woman developed a left temporal lobe abscess after dental extraction and trigeminal nerve block. mNGS identified Aspergillus fumigatus within 24 h (cultures remained negative). Despite two surgical debridements and voriconazole TDM-guided therapy (serum 6.03 μg/mL, CSF 2.34 μg/mL), the abscess progressed, necessitating a third radical debridement with placement of dual intracavitary catheters. Intracavitary caspofungin (5 mg/day) via the catheter achieved rapid clinical response despite a caspofungin MIC of 8 mg/L (non-wild-type). Six-month follow-up showed near-complete resolution. Conclusions: This case demonstrates a multimodal strategy for managing complex intracranial aspergillosis, integrating mNGS for rapid diagnosis, staged debridement for source control, and TDM-guided systemic therapy complemented by intracavitary antifungal administration. This approach offers a viable blueprint for overcoming pharmacological barriers in CNS fungal infections.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Duan, M., Li, Y., Yan, H., et al. (2026). Intracavitary Caspofungin for refractory cerebral aspergillosis: a multimodal approach with mNGS and TDM. Interdisciplinary Neurosurgery. https://doi.org/10.1016/j.inat.2026.102325