Management of allergic fungal sinusitis with intracranial spread

Abstract

Allergic fungal sinusitis (AFS) is a form of paranasal nasal disease if not managed early often involves bone destruction and extension into the orbit and anterior skull base. We present our study of patients with AFS with intracranial, exdradural extension. This study includes our experience of 26 patients with the histological and immunological diagnosis of AFS based on findings of branching septate fungi interspersed with eosinophilic mucin and Charcot-Leyden crystals without fungal invasion of soft tissue, with intracranial extension. All had erosion of bone, which was observed on computerized tomography (CT) scans, extending intracranially and eight had disease that additionally involved the lamina papyracea. The average age of patients in this study was 25 years (range 9-46). There were 20 male and 6 female patients. All patients were immunocompetent. Skin test against aspergillin showed all patients had Type 1 hypersensitivity. All patients underwent transnasal and/or transmaxillary endoscopic approaches for debridement and eight underwent orbital decompression. No patient underwent craniotomy for removal of intracranial extradural disease. No patient had a cerebrospinal fluid leak. Postoperatively, all 26 were treated with a course of corticosteroids. The follow-up period ranged from 2 to 5 years. We conclude AFS is a unique form of fungal disease that might mimic anterior skull base and paranasal sinus tumors. Most cases can be successfully managed with transnasal and/or transmaxillary endoscopic techniques.

Allergic Fungal Rhinosinusitis Involving Frontal Sinus: A Prospective Study comparing Surgical Modalities

“…This observation was contrary to the observation made by Ikram et al 18 where the large series of chronic sinusitis patients were not found to have residual disease.…”

Pediatric allergic fungal rhinosinusitis with extensive intracranial extension – Case report and literature review

“…None required a craniotomy. Postoperatively, all patients received oral steroid therapy for one month (0.5 mg/kg) and remained disease-free for a period of up to 5 years [ 32 ]. In our case, there were no irreversible complications except a recurrent polyp.…”

The Different Clinical Presentations of Allergic Fungal Rhinosinusitis

“…None required craniotomy. Postoperatively, all patients received oral steroid therapy for 1 month (0.5 mg/kg), and remained disease free for a period of up to 5 years [45].…”