Intracranial fungal granulomas are rare and of the histologically verified granulomas, Aspergillus spp. is the commonest causative fungal pathogen. Most of the reported large series of aspergillus granulomas are from countries with temperate climate like India, Pakistan, Sudan, and Saudi Arabia. In contrast to disseminated aspergillosis that occurs in immunosuppressed individuals, most of the intracranial aspergillus granulomas are reported in immunocompetent individuals. The temperature, humidity, high spore content in the atmosphere during ploughing, and occupation as agricultural worker are implicated in the pathogenesis. The sinocranial spread is the most common route of intracranial extension. Extracerebral firm fibrotic lesions and skull base lesions are common. Extensive fibrosis and large number of multinucleated giant cells are the characteristic histological features and these pathological features have therapeutic relevance. 1. Introduction Fungal infections of the central nervous system (CNS) are more frequently reported in the last few decades mostly due to increase in the population at risk, increased awareness, and better diagnostic modalities [1–4]. However, in the recent years there has been increase in the number of CNS fungal infections in immunocompetent individuals [2–12]. Fungi are ubiquitous in nature but have low virulence and cause disease usually when the host defenses are compromised. The fungi enter the CNS by hematogenous route from the systemic focus, or by contiguous spread from paranasal sinuses (PNS), ear or skull bone; or by direct inoculation during trauma or surgical procedure [1–5]. The pathology depends upon the route of spread, host immunity, and type of fungus, hyphae, or yeast. The fungi may involve any part of the neuroaxis, and the pathology includes meningitis, encephalitis, abscess, granuloma, and vasculitis with associated infarction and hemorrhage and aneurysmal formation [1–4, 13]. The type of pathology, to some extent, determines the presenting clinical manifestations. This paper will discuss the experience with intracranial Aspergillus granuloma. 2. Epidemiology The incidence of CNS fungal infections parallels the incidence of systemic fungal infections. The estimated annual incidences of invasive fungal infections caused by Aspergillus species are 12–34 [17]. The reported incidence of CNS involvement associated with invasive aspergillosis is about 4–6% [18]. Intracranial Aspergillus granulomas are rare space occupying intracranial lesions [2–4, 7, 9, 11, 13, 16–21] and most of the reported large series
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