Abstract
Background: Fungal sinusitis is a common disease in healthy
young adults in our locality. It may destroy the skull base and invade
the intra-cranial and intra-orbital compartments causing neurological
and ocular manifestations.
Objectives: The aim of this study is to evaluate the results of combined
neurosurgical and ENT surgical managements for patients with
fungal sinusitis with intracranial extension.
Methods: We managed 10 cases with fungal sinusitis with intracranial
extension. All patients were immune-competent. The average age of
patients in this study was 31.5 year (range 17 - 46 years). There were 6
males and 4 females. All patients presented with headache, 5 with nasal
obstruction and polyps, 5 with unilateral Proptosis, one case with trigeminal
neuralgia and squint, one case with epilepsy and 2 with deterioration
of level consciousness. CT was done in all cases, MRI in 8 patients,
CT angiography and conventional cerebral angiography in one
patient. Surgical intervention was decided according to the relation ofthe fungal granuloma to important intracranial structures. Endonasal
approach alone was done when the granuloma not related to the optic
nerve, internal carotid artery "ICA" or cavernous sinus ( n=3). Combined
subfrontal and endonasal approaches were used when granuloma closely
related to one or more of the previous structures (n=5). Transcranial
approach alone was done in 2 patients with isolated sphenoid fungal sinusitis,
that was associated with a mycotic ICA aneurysm in one patient
and with a temporal lobe abscess in the other. In addition antifungal
treatment was used for 8-12 weeks. patients were followed up
clinically and radiologically for 3 months period.
Results: Showed one patient died 2 months post-operatively from
fungal meningitis. No morbidity related to the operative procedures were
recorded in this stud. Proptosis was completely corrected in the 5 cases.
Follow up CT showed eradication of the fungal granuloma in all surviving
patients. Histologically fungal infection included Aspergillosis and
mucormycosis.
Conclusion: Team ENT and neurosurgical work and early diagnosis
are mandatory in the management of fungal sinusitis with intracranial
extension in immune-competent patients. Surgical planning to the relation
of fungal granuloma to important neurovascular structures is the
corner stone for safe removal of granuloma.
Key words: Invasive fungal sinusitis - intracranial fungal granuloma
- mycotic fungal cerebral aneurysm - fungal brain abscess. |
