Fungal Sphenoiditis Research Articles

Prognostic Model in the Diagnosis and Treatment of Isolated Fungal Sphenoiditis

The study is dedicated to investigating the influence of anatomical peculiarities of the ethmoid sinus and identifying predictors of isolated fungal sphenoiditis development. The introduction highlights the multifactorial nature of the involvement of paranasal sinuses and the relevance of establishing patterns of fungal sphenoiditis development. The methods include a retrospective analysis of 76 patients with isolated sphenoiditis requiring surgical treatment. All participants underwent thorough pre-hospital examination, including computed tomography, endoscopic examination, and in some cases, magnetic resonance imaging. The results show that fungal involvement was observed in 12%, and all subjects exhibited an increased distance from the posterior wall of the middle nasal turbinate to the sphenoid sinus ostium (identified as a prognostic pattern of fungal ball development). Among the complaints, there was a statistically significant difference in ”nasal congestion,” which was more common in fungal infections, and a gender association, as sphenoiditis predominantly affected women. The findings can be utilized for developing effective prevention and treatment methods for this condition. The conclusions emphasize the importance of studying the anatomical parameters of the ethmoid sinus to enhance the diagnosis and treatment of fungal sphenoiditis.

Isolated Sphenoid Sinus Inflammatory Disease-A Report of 14 Cases.

Introduction:Isolated sphenoid sinus inflammatory diseases (ISSIDs) are responsible for about 75% of isolated sphenoid sinus opacifications. Computer tomography (CT) and magnetic resonance imaging (MRI) should be used in a complementary manner for the assessment of ISSIDs. This evaluation sheds some light on the extent of disease and intracranial and intra-orbital involvement.Materials and Methods:The current study aimed to evaluate the medication histories of 14 patients who underwent endoscopic sinus surgery (ESS) for ISSIDs within 2015-2018. This assessment was carried out to analyze the presenting symptoms, diagnostic work-up, additional therapies, and complications. Moreover, it can help us compare our data with pertinent literature.Results:As evidenced by the obtained results, ISSID lesions included bacterial sphenoiditis (42.9%), fungus ball (21.4%), invasive fungal sphenoiditis (14.3%), mucocele (14.3%), and retention cysts (7.1%). In addition, headache was found to be the major complaint, followed by nasal symptoms. Diplopia, and signs and symptoms of the involvement of other cranial nerves were less frequent. All patients underwent endoscopic transnasal sphenoidectomy. The overall survival rate was reported as 92.9% (13/14), and all patients with cranial nerve palsies demonstrated complete clinical remission.Conclusion:Both the review of related literature and our clinical cases were indicative of the dangerous consequences of ISSIDs. Their varied and unspecific presentation and the limited reliability of nasal endoscopy required the cooperation of ENT (ear, nose, and throat) team with other specialists to make an accurate diagnosis and decide on the most appropriate therapeutic choices. If the signs of intracranial complications were detected, surgery should be promptly performed to maximize the chances of recovery.

Complications of Isolated Fungal Sphenoiditis: Patient Clinical Characteristics

Objective: To evaluate the clinical characteristics of patients with complications of isolated fungal sphenoiditis. Materials and Methods: The records of patients diagnosed with isolated fungal sphenoiditis at Songklanagarind Hospital from January 2004 to December 2017 were retrospectively reviewed. Data related to demographics, clinical presentation, underlying disease, type of complication, surgical procedure, and clinical outcome were collected. Results: Among the 35 participating patients, complications were found at a rate of 40%. The most common complication was visual loss (71.43%). We also compared the clinical characteristics between patients with and without complications via univariate analysis. The enrolled patients consisted of 12 men and 23 women (1:2). The mean age was older in the complications group 64 (41–84) vs. 57.43 (36–81) years, respectively. Underlying diabetes mellitus and complete opacity of the sphenoid sinus were factors that related significantly to the occurrence of complications. After treatment, 35.72% of the participants made a complete recovery; underlying diabetes mellitus was associated with a poor prognosis. Conclusion: This report indicates that practitioners must be careful of complications arising in elderly and female patients with isolated fungal sphenoiditis, who have a complete opacity of the sphenoid sinus and underlying diabetes mellitus.

Isolated invasive fungal sphenoid sinusitis – a case study

Invasive fungal sphenoid sinusitis is a rare and potential life threating disease. An incidence rate of fungal sphenoiditis among patients with isolated sphenoid disease varies from 4.5% to 26.8%. Generally the symptoms of sphenoid sinusitis are non-specific and include headaches, visual disorder, post nasal drip, nasal obstruction and paralysis or paresis of single or multiplicitous cranial nerves. In this study, a case of isolated invasive fungal left sphenoiditis in immunocompetent 56-year-old woman is described. The first sinus computed tomography (CT) examination revealed complete opacification of the left sphenoid sinus, she second CT scans showed also erosions of the sphenoid sinus bony walls. Endoscopic sinus surgery was performed and intraoperatively fixed and dilated left pupil was observed thus surgery team decided to finish an operation immediately. Ophthalmologist diagnosed the left oculomotor nerve paresis. Pathologic analysis demonstrated fungal hyphae morphologically identical to Aspergillus spp. Due to suspicion of cerebrospinal fluid (CSF) leak, increasing pneumocephalus and manifestation of mental changes in our subject, endoscopic reoperation with CFS fistula closure was done nine days after the first operation. The patient was treated with intravenous voriconazole and ceftriaxone for one month, and after discharge with itraconazole for 3 months. The full recovery of the left oculomotor nerve function ensued 4 months after surgery and no signs of recurrence of the fungal disease were present up to date.

To the question of the isolated noninvasive fungal sphenoiditis pathogenesis

Noninvasive fungal sinusitis is a widespread disease of the top respiratory tracts. The disease can proceed a long time asymptomatically or have a clinical demonstration with a dominance of a neurologic and ophthalmologic symptomatology. This pathology is surgical disease and successfully responds to treatment. However, unlike a noninvasive mycotic affection of maxillary sinus, when the starting mechanism of mitsetoma grow is invasion of foreign body after stomatologic manipulations, the pathogenesis of the isolated fungal sphenoiditis remains diskutabelny. By analogy, it is suggested about a drift into the sphenoidal sinus under certain conditions of foreign substance, which becomes the trigger of development of a fungal body in a sinus. Based on the analysis of clinical cases we established the reference cliniko-anatomic features, which are defining in a pathogenesis of this disease and can be taken as a basis at differential diagnostics chronic bacteriemic and noninvasive fungalc sphenoiditis. In a pathogenesis deviations of a nasal septum, hypoplasia of nasal turbinates and also considerably oversize of the ostium of a sphenoid sinus have a basic meaning.

The possible failing reasons of balloon catheter dilation procedure in the management of chronic rhinosinusitis

Objective:To investigate the effectiveness of balloon catheter dilation (BCD) in the treatment of chronic rhinosinusitis, and to analyse the possible factors which lead to BCD failure, as well as to provide basic reference for BCD clinical usage.Method:Forty-six sinuses of 32 patients with chronic rhinosinusitis were underwent "Balloon-only" BCD or "FESS assisted" BCD at our institution between September 2014 and December 2016. By recording details of the operation of all the subjects in this study and following up the clinical symptoms, nasal endoscopy, computed tomography of the sinuses, and postoperative complications six months after operation, to evaluate the difficulty, safety, effectiveness and especially, the failing reasons of BCD.Result:BCD was approached in 46 sinuses (19 maxillary sinus, 22 frontal and 5 sphenoid), and succeeded in 13 maxillary sinuses, 19 frontal sinuses, and 4 sphenoid sinuses. Of the 13 maxillary sinuses, there were 9 sinuses underwent "Balloon-only" procedure, other 4 cases underwent "FESS assisted" procedure. There were 3 cases of frontal sinus failed, because of the frontal recess anatomical complexity and the twisted drainage. Of the 5 sphenoid sinuses, 4 cases succeeded, including fungal sphenoiditis cases, in which the mould was completely cleared through the dilated ostia, and 1 case failed. All the patients were followed up for 1, 3 and 6 months of patient's quality of life, nasal endoscope, computed tomography of the sinuses. The results showed that the SNOT-20 scores of the quality of life in significant relief of symptoms, nasal mucosa status improved significantly compared with the preoperative, dilated ostium remains open, no obvious scar formation, no severe operative complications.Conclusion:Balloon catheter dilation in the treatment of chronic rhinosinusitis is safe and effective. But the operation indications is limited, and many factors influence the success rate of BCD, so, preoperatively gaining the information of nasal cavity and anatomical structure around ostium according to patients' nasal endoscopy and sinus CT is critical to success of BCD.

Unilateral Fungal Sphenoiditis Presenting with Diplopia and Ptosis.

Unilateral Fungal Sphenoiditis Presenting with Diplopia and Ptosis.

Differential diagnosis and treatment of isolated pathologies of the sphenoid sinus: retrospective study of 46 cases.

Introduction Isolated disease of the sphenoid is rare and has often been overlooked due to its remote location and difficult access. Objective A retrospective study of the main causes of isolated sphenoid sinus diseases with discussion of the most appropriate methods of diagnosis and treatment. Methods A total of 46 cases of isolated sphenoid disease treated between January 2008 and December 2013 were evaluated by objective ear, nose, and throat examination and video endoscopy, computed tomography of the paranasal sinuses, and, in some cases, magnetic resonance imaging. In each case, we decided between drug and/or endoscopic treatment. Results We identified 12 cases of isolated sphenoiditis (26.1%), 3 cases of fungal sphenoiditis (6.5%), 3 cases of sphenochoanal polyps (6.5%), 22 cases of mucocele (47.8%), 2 cases of cerebrospinal fluid leak (4.3%), and 1 case each of meningoencephalocele (2.1%), inverted papilloma (2.1%), fibrous dysplasia (2.1%), and squamous cell carcinoma (2.1%). Conclusion A prevalence of inflammatory and infectious diseases was found, and endoscopic surgery for the sphenoid sinus approach is effective in treating various diseases of the isolated sphenoid, whether complicated or not.

Invasive fungal sinusitis of the sphenoid sinus.

ObjectiveThis study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival.MethodsA retrospective review of 12 cases of invasive fungal sphenoiditis was conducted.ResultsCases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027).ConclusionThe survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.

A Case of Invasive Fungal Sphenoiditis with Nasal Septal Abscess

A Case of Invasive Fungal Sphenoiditis with Nasal Septal Abscess

A Case of Invasive Fungal Sphenoiditis with Nasal Septal Abscess

A Case of Invasive Fungal Sphenoiditis with Nasal Septal Abscess

Temporal Lobe Abscess in a Patient With Isolated Fungal Sphenoiditis

Pathology References Isolated sphenoid sinusitis accounts for 2-3% of all sinus infections evaluated by radiologic imaging. Fungal sphenoiditis is present in approximately 5% of isolated sphenoiditis. The most common presenting symptom is frontal/retro-orbital headache; this occurs in roughly 70% of cases. Nasal obstruction is the next most common symptom presenting in 30% of cases. Noninvasive fungal sphenoid sinusitis rarely presents with serious complications. However, diplopia and/or transient vision loss have been the most severe reported complications and have been seen in up to 3% of cases. Intracranial extension and cerebral abscess is another serious complication of fungal sphenoiditis, and to our knowledge has not been reported until now. Intracranial extension from sinusitis is a rare but potentially fatal disease characterized by bony erosion of the skull base and fungal extension into the adjacent cavities, such as the orbit or cranial vault. It is usually associated with acute fulminant invasive fungal sinusitis (AFIFS) in the immunocompromised population, such as patients who have undergone hematopoietic stem cell transplantation or solid organ transplant, those with HIV/AIDS or diabetes mellitus, or those who are undergoing treatment with chemotherapy or immunosuppressants.3, 4 However, this complication has now been shown to very rarely occur in immunocompetent individuals as well, and seems to be increasing in frequency in this population.4-7 Of the approximately twenty pathogenic fungi, the three most common fungal infections in the nasal sinuses are the opportunistic genera of Aspergillus, Mucor, and Candida, of which Aspergillus is the most prevalent organism.1, 8 While rare, each of these can invade the adjacent structures, with Mucor being the most invasive and requiring the most aggressive surgical treatments. Intracranial extension and abscess formation most commonly occurs from the frontal sinus to the frontal and frontoparietal areas of the brain. 4 The rarest occurrence of invasive fungal sinusitis is seen in the sphenoid sinus, due to only 2.7% of all sinus infections occurring there.9 The rarity of this infection in comparison to other sinuses is because of both the anatomical orientation of the sphenoid sinus receiving little directed airflow, and because the sinus mucosa is lined by relatively few glands, producing less mucus to serve as a reservoir for infection.10 When invasion does occur from the sphenoid sinus, it can occur through one of two mechanisms: retrograde thrombophlebitis through diploic veins of the skull, or by direct extension through normal anatomic pathways or wall erosion.11 The fungus can either enter the frontoparietal areas of the brain similar to extension from the frontal and ethmoid sinuses, or it can extend into the cavernous sinus, causing visual defects secondary to destruction of cranial nerves III, IV, V, and VI. Another potential site of invasion is the temporal lobe, which has rarely been documented.10, 11 Case Report

Imaging of the Internal Carotid Artery and Adjacent Skull Base with Three-Dimensional CT Angiography for Preoperative Planning and Intraoperative Surgical Navigation

Introduction: Three-dimensional computed tomographic angiography (3D-CTA) demonstrates the spatial relationships of the internal carotid artery (ICA) and adjacent skull base. This imaging modality may be incorporated into intraoperative surgical navigation. Methods: The charts of all patients who had undergone 3D-CTA imaging between July 2002 and June 2004 were reviewed. For 3D-CTA, 1-mm axial CT scan images were obtained with simultaneous intravenous contrast bolus on a multidetector CT scanner. The CBYON Suite version 2.6–2.8 (Med-Surgical Services, Inc., Mountain View, CA) was used to create CTA images through its volume-rendering protocols. Results: A total of 20 patients had 21 3D-CTA studies performed for diagnostic evaluation and/or preoperative planning and in 16 instances, the 3D-CTA images were used during intraoperative surgical navigation. The diagnoses included neoplasm (7 malignant and 4 benign), fibro-osseous lesion (2), fungal sphenoiditis (2), CSF leak (2), mucocele (1), and other (2). Images generated by 3D-CTA helped easily define the anatomic relationships between the ICA and skull base lesion. During intraoperative surgical navigation, the 3D-CTA provided critical information about the ICA location and adjacent skull base anatomy in the operative field. Conclusion: 3D-CTA is a useful means for assessing the ICA and its relationship to skull base lesions. Incorporation of 3D-CTA into intraoperative surgical navigation facilitates the comprehension of operative field anatomy in the ICA region. As a result, this imaging technique, especially when combined with intraoperative surgical navigation, may enhance surgical outcomes. This strategy extends the applications of minimally invasive endoscopic approaches to the skull base.

動眼神経麻痺のみを呈した蝶形骨洞アスペルギルス症例

An 80-year-old male consulted the Department of Ophthalmology for headache, left blepharoptosis, and diplopia, and was diagnosed with left oculomotor paralysis. Neurological examinations revealed no abnormalities. A shadow was detected in the sphenoid sinus, and the patient was referred to the Department of Otorhinolaryngology. CT revealed a shadow in which the inner area was not uniform, without bone destruction, in the left sphenoid sinus. Under a tentative diagnosis of sphenoiditis-related oculomotor paralysis, endoscopic sphenoidectomy was performed. The sphenoid sinus was occupied by a fungal mass, suggesting fungal sphenoiditis. In the sinus, there was no bone defect. After surgery, conservative therapy such as steroid therapy and follow-up were continued. After 2 months, oculomotor paralysis subsided. Aspergillus was detected in the fungal mass. We reviewed the literature regarding the pathogenesis of peripheral cranial paralysis related to noninvasive mycosis of the sphenoid sinus.