Bhuskute Govind Shripad, Keshri Amit Kumar, Seduchidambaram Malathy, Dubey Abhishek, Hameed Nazrin, Chidambaram Kalyan, Muraleedharan Manjul, Das Kuntal Kanti, Mehrotra Anant, Srivastava Arun, Jaiswal Awadesh, Kumar Raj, Manogaran Ravi Sankar
Neurotology Unit, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Neurol Surg B Skull Base. 2023 Aug 29;85(5):458-464. doi: 10.1055/a-2148-2259. eCollection 2024 Oct.
To study the etiological and anatomical factors in pathophysiology of invasive fungal rhinosinusitis affecting the skull base. Retrospective clinical study over 5 years. Single-center tertiary referral hospital. All cases of invasive fungal rhinosinusitis with clinicoradiological and/or operative evidence of anterior and central skull base, orbit, and orbital apex involvement with or without intracranial disease were included in the study. Patients with a sinonasal-palatal disease without the involvement of the skull base or orbit were excluded from the study. In addition, we assessed the risk factors such as coronavirus disease 2019 (COVID-19) infection, diabetes mellitus (DM), and other immunocompromised conditions. There were 79 patients, of which 65.8% had skull base rhino-oribitocerebral mucormycosis (ROCM), and 34.2% had infection. The mean duration from onset of the symptom to presentation of ROCM was 36.75 ± 20.97 days, while for the group was 21 weeks. The majority of patients (66%) with ROCM presented after 30 days of symptom onset. Among ROCM patients, 88.7% had a history of COVID-19 infection, and 96% had DM. In 40.8% of patients with infection, the tissue diagnosis was unavailable, and galactomannan assay and clinicoradiological assessment were used for diagnosis. The most common area of the skull base involved was the pterygopalatine fossa (88.5%), followed by the infratemporal fossa (73.1%). The most common neurovascular structure (75%) involved was the pterygopalatine ganglion and the infraorbital nerve. With the increasing incidence of invasive fungal infections worldwide, particularly after the COVID-19 pandemic, it is crucial to understand the evolving nature of this disease. ROCM, documented in the literature to cause fulminant disease, became a chronic illness, possibly due to the improvement of the patient's immunity during the disease course.
研究侵袭性真菌性鼻-鼻窦炎累及颅底的病理生理学中的病因及解剖学因素。
为期5年的回顾性临床研究。
单中心三级转诊医院。
本研究纳入所有具有临床放射学和/或手术证据表明累及前颅底和中颅底、眼眶及眶尖且伴有或不伴有颅内病变的侵袭性真菌性鼻-鼻窦炎病例。鼻窦-腭部疾病但未累及颅底或眼眶的患者被排除在研究之外。此外，我们评估了诸如2019冠状病毒病（COVID-19）感染、糖尿病（DM）及其他免疫功能低下状况等危险因素。
共有79例患者，其中65.8%患有颅底鼻-眶-脑毛霉菌病（ROCM），34.2%患有 感染。ROCM从症状出现到确诊的平均病程为36.75±20.97天，而 组为21周。大多数ROCM患者（66%）在症状出现30天后确诊。在ROCM患者中，88.7%有COVID-19感染史，96%有DM。在40.8%的 感染患者中，无法进行组织诊断，采用半乳甘露聚糖检测及临床放射学评估进行诊断。颅底最常受累的区域是翼腭窝（88.5%），其次是颞下窝（73.1%）。最常受累的神经血管结构（75%）是翼腭神经节和眶下神经。
随着全球侵袭性真菌感染发病率的上升，尤其是在COVID-19大流行之后，了解这种疾病的演变性质至关重要。文献记载ROCM可导致暴发性疾病，但它可能已成为一种慢性病，这可能是由于患者在病程中免疫力有所改善。
