Invasive aspergillosis of the paranasal sinuses and the skull base

Invasive aspergillosis (IA) originating from the paranasal sinuses can cause an intracranial growth mainly along the skull base and larger vessels. This study reports our experience in the diagnosis and treatment of a series of patients with IA. A retrospective chart review of four patients with chr...

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Bibliographic Details
Published in:European archives of oto-rhino-laryngology 2007-10, Vol.264 (10), p.1163-1169
Main Authors: KNIPPING, Stephan, JUERGEN HOLZHAUSEN, Hans, KOESLING, Sabrina, BLOCHING, Marc
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome - epidemiology
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Bacterial Agents - therapeutic use
Aspergillosis - complications
Aspergillosis - epidemiology
Aspergillosis - therapy
Biological and medical sciences
Combined Modality Therapy
Debridement
Emergency and intensive care: techniques, logistics
Female
Human mycoses
Humans
Hyperbaric Oxygenation - methods
Immunocompromised Host
Infectious diseases
Injections, Intravenous
Intensive care medicine
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Miscellaneous mycoses
Mycoses
Otorhinolaryngology. Stomatology
Paranasal Sinus Diseases - microbiology
Paranasal Sinus Diseases - pathology
Paranasal Sinus Diseases - therapy
Perfusions. Catheterizations. Hyperbaric oxygenotherapy
Skull Base - microbiology
Skull Base - pathology
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Summary:Invasive aspergillosis (IA) originating from the paranasal sinuses can cause an intracranial growth mainly along the skull base and larger vessels. This study reports our experience in the diagnosis and treatment of a series of patients with IA. A retrospective chart review of four patients with chronic invasive intracranial aspergillosis was performed. Clinical signs, physical examinations, radiographs, histological samples, and outcome were demonstrated. The patients demonstrated different symptoms like exophthalmus, ophthalmoplegia, loss of vision, and hypaesthesia of the ophthalmic and maxillary nerve. Computed tomography and MRI revealed extensive sino-orbital and skull base lesions. The patients were treated with aggressive endonasal debridement, intravenous antifungal agents and daily irrigations with antimycotic suspensions. Furthermore, we applied hyperbaric oxygenation. Two patients died from complications due to subarachnoidal hemorrhage and accompanied complications respectively. Despite the high mortality rate patients with an invasive aspergillosis can be effectively treated in some cases by an early and rigorous treatment schedule using all surgical and conservative therapeutic options.
ISSN:0937-4477
1434-4726
DOI:10.1007/s00405-007-0336-7