Gupta A K, Mann S B, Khosla V K, Sastry K V, Hundal J S
Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Mycoses. 1999;42(4):225-30. doi: 10.1046/j.1439-0507.1999.00470.x.
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.
鼻窦真菌感染在亚洲南部屡有报道。曲霉菌和毛霉菌是主要的致病菌。鼻窦真菌病向颅内蔓延是一个难以处理的问题。我们报告了18例伴有颅内蔓延的鼻窦真菌病病例。最常见的表现是鼻分泌物增多（67%）、鼻塞（50%）、眼部症状如眼球突出（44%）、内眦间距增宽（39%）和眼球运动障碍。计算机断层扫描对于了解疾病的性质和范围很有帮助（敏感性为100%，特异性为78%）。与仅采用颅外入路（12例）相比，联合颅内-颅外入路（6例）具有明显优势。仅采用颅外入路时，脑脊液漏发生率为17%，且在采用该方法治疗的12例中有4例复发（P<0.05）。联合颅内-颅外治疗的发病率略有增加，但该方法未出现复发或严重并发症。
