Baeesa Saleh S, Bokhari Rakan F, Alghamdi Khalid B, Alem Hisham B, Al-Maghrabi Jaudah A, Madani Tariq A
Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Otorhinolaryngology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Asian J Neurosurg. 2017 Apr-Jun;12(2):172-179. doi: 10.4103/1793-5482.144188.
Invasive sinonasal aspergillosis is a silently progressive disease that, left untreated, may invade the adjacent intracranial and intra-orbital compartments incurring serious morbidity.
To evaluate our results of a collaborative surgical management plans for patients with invasive sinonasal aspergillosis with orbitocranial extension.
Retrospective study.
Between the years 2000 and 2012, 12 patients with Aspergillus sinusitis with orbitocranial extension were treated at our institution. Preoperative CT and MRI scans were done in all cases and cerebral angiography in two patients with subarachnoid hemorrhage (SAH). Surgical combined transcranial and endonasal approaches to the skull base were considered in all patients. Adjuvant antifungals were administered postoperatively with regular clinical and radiologic follow up.
All cases had a long history of headache and nasal obstruction ( = 12). Five presented with unilateral proptosis, one with meningitis, one with epilepsy, two with SAH, and one patient presented with trigeminal neuralgia. Craniotomy alone was chosen for the patients with isolated sphenoiditis ( = 2) while a combined cranial and endonasal approach was elected for the other patients ( = 10). Adjuvant antifungal therapy was used for 3-12 months. Patients were followed up clinically and radiologically for an average 36-month period (range = 12-50 months) with disease eradication achieved in eight patients (67%). Two died as consequence to SAH. Follow up also showed that three patients (25%) had sinunasal recurrence requiring evacuation through an endonasal approach.
Surgical intervention, with adjuvant antifungal therapy, aiming for safe total removal of the fungal burden, whenever feasible, has a major role in the management of invasive sinonasal aspergillosis with orbitocranial extension with minimal morbidity and good outcomes.
侵袭性鼻窦曲霉菌病是一种渐进性疾病，若不治疗，可能会侵犯相邻的颅内和眶内间隙，导致严重的发病率。
评估我们对侵袭性鼻窦曲霉菌病伴眶颅扩展患者的联合手术治疗方案的结果。
回顾性研究。
2000年至2012年间，我院治疗了12例伴有眶颅扩展的曲霉菌性鼻窦炎患者。所有病例均进行了术前CT和MRI扫描，2例蛛网膜下腔出血（SAH）患者进行了脑血管造影。所有患者均考虑采用经颅和鼻内联合入路至颅底。术后给予辅助抗真菌药物治疗，并定期进行临床和影像学随访。
所有病例均有长期头痛和鼻塞病史（n = 12）。5例出现单侧眼球突出，1例出现脑膜炎，1例出现癫痫，2例出现SAH，1例出现三叉神经痛。单纯蝶窦炎患者（n = 2）选择开颅手术，其他患者（n = 10）选择颅鼻联合入路。辅助抗真菌治疗持续3 - 12个月。对患者进行了平均36个月（范围 = 12 - 50个月）的临床和影像学随访，8例患者（67%）疾病根除。2例因SAH死亡。随访还显示，3例患者（25%）鼻窦复发，需要通过鼻内入路清除。
手术干预联合辅助抗真菌治疗，尽可能安全地完全清除真菌负荷，在侵袭性鼻窦曲霉菌病伴眶颅扩展的治疗中起着重要作用，发病率低，效果良好。
