Non‐randomized comparison of surgical modalities for paranasal sinus mycoses with intracranial extension

Abstract

Mycotic infections of paranasal sinuses are frequently reported in southern Asia. Aspergillus and Mucor species are the predominant ones. Intracranial extension of paranasal sinus mycoses is a difficult problem to manage. We report 18 cases of paranasal sinus mycoses with intracranial extensions. The commonest manifestations were nasal discharge (67%), nasal obstruction (50%), ocular symptoms such as proptosis (44%), telecanthus (39%) and ophthalmoplegia. Computerized tomography scans were found to be quite informative regarding the nature and extent of the disease (100% sensitivity and 78% specificity). A combined intracranial-extracranial approach (six cases) gave a distinct advantage over only adopting an extracranial approach (12 cases). A 17% incidence of CSF leak was noted by adopting only an extracranial approach as well as a recurrence in four cases out of the 12 that were treated using this method (P < 0.05). A slight increase in morbidity was associated with the combined intracranial-extracranial treatment, but no recurrence or significant complications were noted in this approach.

Fulminant Mucormycosis Involving Paranasal Sinuses: A Rare Case Report

“…Foci of hyperdensity in the affected sinus on CT scans are highly suggestive of fungal disease [11]. CT is 100% sensitive and 78% specific in the diagnosis of sinonasal mycosis [12]. The phycomycetes and Aspergillus are the most common opportunistic pathogens in immunocompromised patients [13].…”

Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence‐Based Review with Recommendations

“…reported a case of AIFS with brain involvement that survived without recurrence after surgical debridement 37 . With few studies reporting the utility of intracranial debridement on survival in AIFS patients with intracranial extension, there appears to be an uncertain role for surgery in limiting recurrence and improving survival, 226–229 particularly considering the challenge of skull base reconstruction after tissue resection from direct sinus‐to‐brain invasion in the setting of critical illness, active infection, coagulopathy, and the potential need for repeated debridement.…”

Acute Chiasmal Abscess Resulting from Perineural Extension of Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

“…Nonetheless, invasive sino-orbital aspergillosis may occur in immunocompetent patients (3, 17, 18, 29, 30, 32, 35, 43). The standard treatment for invasive sino-orbital disease has been radical surgical intervention, including orbital exenteration, sinus excision, and aggressive intracranial debridement (9, 13, 22, 31). However, more recently, good outcomes have been reported with a combination of limited surgical debridement and antifungal drug therapy, especially in immunocompetent patients (1, 21, 27).…”