Chakravarty Sharmistha, Nagarkar Nitin M, Mehta Rupa, Arora Ripudaman, Ghosh Amritava, Sharma Anil Kumar, Satpute Satish, Aggarwal Aakash
G.E. Road, Tatibandh, Raipur, Chhattisgarh 492099 India Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences.
Raipur, Chhattisgarh India Department of Endocrinology and Metabolism, All India Institute of Medical Sciences.
Indian J Otolaryngol Head Neck Surg. 2023 Apr 8;75(3):1-13. doi: 10.1007/s12070-023-03717-1.
The base of skull forms the first line of barrier to be breached in the transition of rhino-orbito-palatal forms of mucormycosis to intracranial forms with various neurological deficit. The pattern of base of skull erosion has prognostic implications in overall recovery and survival of the patient. The aim of the study was to assess the pattern of skull base involvement in cases of rhino-orbital-cerebral mucormycosis (ROCM) in terms of clinical presentations, radiological findings, intraoperative illustrations and post operative recovery. This is a retrospective single centre study of Covid associated Mucormycosis (CAM) patients with skull base involvement at a tertiary referral centre of central India from May 2021 to October 2021. Amongst a total of 248 patients of CAM, 54 patients with skull base involvement were included in our study. The cases were stratified into basifrontal-BF (15%), basisphenoid-BS (20%), orbital apex-OA (15%), basiocciput-BO (26%), frontal bone osteomyelitis-FBO (22%) and sphenoid bone osteomyelitis-SBO (2%), based on their pattern of involvement of skull base and intracranial spread. Early ethmoid and cribriform plate involvement progressed to frontal lobe abscess while early maxillary disease progressed to developed temporal lobe abscess. The orbital apex lesions had early onset cavernous sinus thrombosis. Analysis of clinical manifestations and postoperative follow up revealed an emerging pattern where Posterosuperior lesions of paranasal sinuses (Ethmoid, roof of maxilla and orbit) progressing to BF, BS, OA, FBO and SBO had poorer treatment outcome than Anteroinferior (Floor of maxillary sinus, palate) based lesions which involved BO of skull base. The inferiorly located diseases had better prognosis, less duration of hospital stay, lesser mortality and decreased need for second surgery. There exists a temporal relation of the initial site of fungal load in sinonasal region to their subsequent intracranial spread. Classification into subtypes helped in disease stratification which helped in prognostication and surgical planning. Early intervention by multidisciplinary team improved survival outcome.
在鼻眶腭型毛霉菌病转变为伴有各种神经功能缺损的颅内型的过程中，颅底是首先被突破的一道屏障。颅底骨质侵蚀的模式对患者的整体恢复和生存具有预后意义。本研究的目的是从临床表现、影像学检查结果、术中所见及术后恢复情况等方面，评估鼻眶脑型毛霉菌病（ROCM）患者颅底受累的模式。这是一项对2021年5月至2021年10月期间印度中部一家三级转诊中心收治的伴有颅底受累的新冠相关毛霉菌病（CAM）患者进行的回顾性单中心研究。在总共248例CAM患者中，54例伴有颅底受累的患者被纳入我们的研究。根据颅底受累及颅内扩散的模式，这些病例被分为额底部-BF（15%）、蝶骨底部-BS（20%）、眶尖-OA（15%）、枕骨底部-BO（26%）、额骨骨髓炎-FBO（22%）和蝶骨骨髓炎-SBO（2%）。筛窦和筛板早期受累会进展为额叶脓肿，而早期上颌窦病变会进展为颞叶脓肿。眶尖病变早期会出现海绵窦血栓形成。对临床表现和术后随访的分析揭示了一种新的模式，即鼻窦的后上病变（筛窦、上颌窦顶和眶）进展为BF、BS、OA、FBO和SBO的治疗效果比涉及颅底BO的前下病变（上颌窦底、腭）更差。位置较低的疾病预后较好，住院时间较短，死亡率较低，二次手术需求减少。鼻窦区域真菌负荷的初始部位与其随后的颅内扩散之间存在时间关系。分类为亚型有助于疾病分层，从而有助于预后评估和手术规划。多学科团队的早期干预改善了生存结果。
