Endoscopic endonasal trans-cribriform approachfor drainage of frontal lobe abscess in invasivemucormycosis – A case report

Abstract

Abstract Introduction:Mucormycosis is a belligerent fungal infection that can cause fatal complications. Patients at risk arethose with poorly controlled diabetes mellitus, and similar immunosuppressed states. Tissue invasion and infarctionsecondary to angioinvasion are the pathognomonic features of the disease. The management of brain abscesseshas become increasingly complicated requiring close collaboration between various departments encompassinginfectious disease specialists, neurologists, radiologists and neurosurgeons. ENT surgeons are seldom involved inthe management of brain abscesses, but with the advancements in Endoscopic Sinus Surgery techniques, ENTsurgeons are now treating the skull base, meningeal and brain pathologies.Methods:A case report of a 36-year-old male with complaints of headache, left-sided facial pain, difficultyin opening left eye for 10 days, with a history of one episode of generalized seizure that lasted for 4 min,recently detected type 2 diabetic mellitus. Local examination revealed left-sided nasal crusting and an old palataldefect. KOH mount was positive for mucorales. CT scan PNS revealed left-sided maxillary, ethmoidal, sphenoidalfrontal sinusitis with erosion of left lamina papyracea, left extraconal and intraconal involvement with erosion ofleft cribriform plate. MRI brain revealed additional hyperdensities in both medial frontal, and parietal lobe withdiffusion restriction. The patient underwent left-sided endoscopic sinus surgery with endoscopic endo- nasal trans-cribriform drainage of frontal lobe abscess, with retro bulbar Amphotericin B injection, with a neurosurgical team onstandby in the event of unexpected complications. The eschar and pus drained from the frontal lobe abscess wassent for histopathological examination, culture and sensitivity. The patient was extubated, and the postoperativeperiod was uneventful.