Benefit of Endoscopic Surgery in the Management of Acute Invasive Skull Base Fungal Rhinosinusitis: Clinical Morbidity and Outcome in a 20-Year Period
Notice bibliographique
Résumé
Introduction: Acute fungal rhinosinusitis, often seen among immunocompromised patients, is a rapidly progressive, life-threatening condition associated with poor prognosis. Surgical debridement can be challenging when infection is associated with skull base extension. Recent studies have shown that aggressive endoscopic sinus surgery can be effective in removing invasive disease. We reviewed clinical characteristics of patients who underwent endoscopic surgical debridement of acute fungal rhinosinusitis to evaluate postoperative outcomes and risk for recurrence. We present a series of 14 patients with clinically and histopathologically confirmed skull base fungal rhinosinusitis who underwent pure endoscopic surgery. Methods: We performed a retrospective analysis of patients with skull base fungal rhinosinusitis treated with an endoscopic surgical approach at our institution from 1998 to 2018. Demographic and clinical data including age, sex, underlying comorbidities, presenting symptoms, physical exam findings, radiologic findings, preoperative course, operative procedure, postoperative complications, number of debridements, histologic and microbiologic findings, length of stay, and postoperative course were reviewed. Results: Fourteen patients underwent endoscopic removal of fungal sinusitis. Five patients (35.7%) were women and nine (64.3%) were men. Median age at the time of primary surgery was 66.1 years (range, 24.9–84.5). The most common underlying medical comorbidities were hematologic malignancy in nine (65.3%) patients and poorly controlled diabetes in seven (50%) patients. Mean HbA1c for diabetic patients was 7.7%. Presenting symptoms included headache (50%), eye pain (42.9%), facial pain (28.6%), visual changes (21.4%), and congestion (14.3%). One patient presented with left-side proptosis and a left cranial nerve six palsy. In another patient, fungal sinusitis was identified incidentally during MR stroke evaluation. Radiologic findings included hyperdensity of multiple sinuses (28.6%) and skull base erosion (21.4%). The most common fungi were Mucormycosis (42.9%) and Aspergillus (35.7%). Fungal cultures were obtained in all patients; nine (64.3%) demonstrated positive growth after 28 days of incubation. 71.4% of patients received preoperative antibiotics, 28.6% received preoperative antifungals, and 28.6% received preoperative steroids. Postoperatively, 98.9% of patients received antibiotics, 100% received antifungals, and 42.9% received steroids. Twelve (85.7%) patients underwent a purely endoscopic surgical approach, and two (14.3%) patients had a combined endoscopic and open approach. 11 (79.6%) patients had invasive disease, three (21.4%) had noninvasive disease. Eight (57.1%) patients subsequently developed recurrence and required multiple surgical debridements. The mean number of debridements was 1.5. Median time to second surgery was 11 days. Six (42.9%) patients died during their postoperative recovery. One mortality was due to massive epistaxis leading to hypovolemic shock. The remaining eight (57.1%) patients were discharged postsurgery. Median time to discharge was 23 days. Conclusion: Acute fungal rhinosinusitis is a rare complication of immunocompromised patients. Surgical intervention is an option for definitive management; however, postoperative mortality and risk of recurrence requiring additional surgical interventions remains high. Patients with diabetes had a better prognosis than those with a hematological malignancy. Due to the long delay of obtaining positive fungal cultures and pathology, we advocate early aggressive multimodal treatment. Multiple debridements may be necessary in most cases and close surveillance is needed during treatment.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».