Deep brain fungal granuloma (review)

48 year old male presented with complains of headache, giddiness, decreased vision in both eyes. Patient had no history of any comorbidity, had history of covid infection 6 months back. He consulted opthalmologist first who found left 6th nerve palsy and advised Mri brain which was s/o Right gangliocapsular SOL with mass effect and midline shift. He was anticipated to have 90% chance to get left sided hemiparesis due to sol situated in basal ganglia and internal capsule.
Stategy:- 1)we done surgery and chosen trajectory from inferior frontal gyrus so as to avoid basal ganglia/ internal capsule during tumor excision.
2) tumor was well encapsulated so less damage to surrounding structures. 3) tumor was removed in small peices and not in total so as to avoid damage to surrounding vital centers.
We suceesfully removed SOL completely and avoided postop hemiparesis. Postop he had brain swelling hence bone flap was removed.Patient was discharged in 5 days without neurodeficit. Post op histopathology was suggestive of granulomatous lesion with fungal hyphae and spores. Such a rare to have fungal granuloma at this location in perfectly healthy man. Postop he is given iv antifungal on opd basis. Preop post scans are shown. Short intraoperative edited vdo is shown.