Shires Courtney B, Boughter John D, Cox Steven
West Cancer Center, Germantown, TN, USA.
Department of Anatomy & Neurobiology - University of Tennessee Health Science Center, Memphis, TN, USA.
Am J Otolaryngol. 2024 Nov-Dec;45(6):104478. doi: 10.1016/j.amjoto.2024.104478. Epub 2024 Aug 2.
Allergic fungal sinusitis (AFS) is a form of paranasal mycosis that often involves bone destruction and can extend into the orbit and anterior skull base. Intracranial and intraorbital involvement are published but not both in each included patient of a series. The purpose of the present study was to review cases of extensive AFS with orbital or/and skull base erosion, including the presenting symptoms, patient socioeconomic background, imaging features, surgical technique, and post-operative outcomes.
The records of 30 patients with the histological diagnosis of AFS and both intracranial and intraorbital involvement were reviewed.
The average age of the patients was 25.2 years. 83 % of patients were male. 70 % were African American. 66 % of patients had Medicaid or were uninsured. Presenting symptoms were headaches (80 %), nasal obstruction (33 %), proptosis (40 %), vision change (23 %), facial pressure (10 %), and decreased sense of smell (7 %). 100 % of patients had bone erosion observed on computerized tomography scans with disease extending intracranially through the anterior skull base or posterior wall of the frontal sinus along with disease that eroded through the lamina papyracea. All patients had failed medical management. All patients underwent surgery by Otolaryngology, Ophthalmology, and Neurosurgery with transnasal endoscopic approaches and orbitotomy. 80 % also underwent a bifrontal craniotomy for removal of intracranial extradural disease with cranialization. 53 % of patients had orbital implants remaining after surgery; 23 % had nasal stents. There were no postoperative cerebrospinal fluid leaks. Average hospital stay was 4.8 days. Preoperatively, 13 % of patients underwent allergy testing. 94 % saw an Allergist postoperatively. 21 % required follow up surgery.
A team approach of Otolaryngologists, Ophthalmologists, and Neurosurgeons is recommended for this slowly growing but locally destructive disease. Most patients with AFS will present with headaches and nasal obstruction. While most cases of AFS can be successfully managed with transnasal endoscopic techniques, orbitotomy and craniotomy represents an effective treatment for severe AFS cases with extensive intracranial and intraorbital involvement. This disease is found most commonly in young African American males and in the underinsured.
变应性真菌性鼻窦炎（AFS）是鼻窦霉菌病的一种形式，常累及骨质破坏，并可蔓延至眼眶和前颅底。颅内和眶内受累情况均有报道，但在系列研究的每例纳入患者中并非同时出现这两种情况。本研究的目的是回顾伴有眼眶或/和颅底骨质侵蚀的广泛性AFS病例，包括临床表现、患者社会经济背景、影像学特征、手术技术及术后结果。
回顾30例经组织学诊断为AFS且同时有颅内和眶内受累的患者记录。
患者平均年龄25.2岁。83%为男性。70%为非裔美国人。66%的患者有医疗补助或未参保。临床表现为头痛（80%）、鼻塞（33%）、眼球突出（40%）、视力改变（23%）、面部压迫感（10%）及嗅觉减退（7%）。100%的患者在计算机断层扫描上观察到骨质侵蚀，病变通过前颅底或额窦后壁向颅内蔓延，同时病变侵蚀纸样板。所有患者药物治疗均失败。所有患者均接受了耳鼻喉科、眼科和神经外科联合手术，采用经鼻内镜入路和眼眶切开术。80%的患者还接受了双额开颅手术，用于清除颅内硬膜外病变并行颅骨化。53%的患者术后留有眼眶植入物；23%的患者留有鼻支架。术后无脑脊液漏。平均住院时间为4.8天。术前，13%的患者进行了过敏试验。94%的患者术后看了过敏症专科医生。21%的患者需要再次手术。
对于这种生长缓慢但具有局部破坏性的疾病，建议采用耳鼻喉科医生、眼科医生和神经外科医生的团队治疗方法。大多数AFS患者会出现头痛和鼻塞。虽然大多数AFS病例可通过经鼻内镜技术成功治疗，但眼眶切开术和开颅手术是治疗伴有广泛颅内和眶内受累的严重AFS病例的有效方法。这种疾病最常见于年轻的非裔美国男性和未参保人群。
