Intracranial Extension Research Articles

Challenging the Role of Subtotal Resection Following Proton Radiotherapy for Adenoid Cystic Carcinoma of the Head and Neck

To report long-term outcomes of patients with adenoid cystic carcinoma (ACC) of the head and neck treated with proton radiotherapy. On this IRB-approved, single institutional prospective outcomes registry, 56 patients were included with de novo, nonmetastatic adenoid carcinoma of the head and neck treated with primary (n = 9) or adjuvant proton therapy from June 2007 to December 2021. The cohort had 30 women and 26 men with a median age of 57 years (range, 10-81 years). Twenty-nine percent (n = 16) had intracranial extension, 23% (n = 13) had orbital extension, and 55% (n = 31) had clinical cranial nerve involvement at the time of radiotherapy. Thirty patients underwent gross total resection (GTR), 26 had gross disease at the time of treatment undergoing a subtotal resection (STR) (n = 17) or biopsy alone (n = 9). The median dose to the primary site was 72.6 GyRBE (range, 64-74.4 GyRBE) delivered in either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received either elective nodal irradiation (ENI) in a node negative neck or concurrent chemotherapy. With a median follow-up of 6.2 years (range, 0.9 - 14.7 years), the 5-year local-regional control (LRC), disease free survival (DFS), cause-specific survival (CCS) and overall survival (OS) were 88%, 85%, 89%, and 89%, respectively. Cranial extension (p = 0.003) and gross residual tumor (p = 0.0388) were factors associated with decreased LRC. While LRC for those with a GTR was 96%, those with STR or biopsy alone were 81% and 76%, respectively. T-stage (p = 0.0154), cranial extension (p = 0.0056), extent of resection (p = 0.0355), and gross residual tumor (p = 0.0094) were associated with decreased DFS. T-stage (p = 0.0099), extent of surgery (p = 0.029) and gross residual tumor (p.0071) were associated with decreased CCS. The 5-year cumulative incidence of clinically significant late grade ³3 toxicity was 15% and the crude incidence at most recent follow-up was 23% (n = 13). There was no LRC benefit with ENI (p = 0.94). Proton therapy provides excellent disease control for head and neck ACC with acceptable toxicity. Gross residual disease at the time of treatment and intracranial involvement were significant prognostic features for worse outcomes. STR did not confer benefit over biopsy only at 5-years and may question the role of extensive and morbid operations if GTR is not technically feasible.

Pneumocephalus and meningoencephalitis as a complication of otitis media in a dog

AbstractA 3‐year‐old Maltese dog presented with vestibular signs that worsened after a grass seed was removed from the right external ear canal. Neurological examination was suggestive of a brainstem lesion. Magnetic resonance imaging of the head was performed, and findings were consistent with infectious meningoencephalitis and otogenic pneumocephalus secondary to intracranial extension of right otitis media. A culture of the right middle ear effusion yielded Staphylococcus epidermidis. The dog was euthanased under general anaesthesia due to worsening of the cardiovascular and respiratory parameters. Pneumocephalus in dogs has been described secondary to surgery, trauma, meningocele and meningoencephalocele. To the authors' knowledge, this is the first case report describing otogenic pneumocephalus in a dog.

Nasopharyngeal Carcinoma Mimicking Sinonasal Undifferentiated Carcinoma

Nasopharyngeal carcinoma (NPC) is a tumor arising from the epithelial cells that covers the surface and lining of the nasopharynx. It is divided into keratinizing squamous cell carcinoma, and non-keratinizing carcinoma, which can be further divided into differentiated and undifferentiated subtypes. Symptoms of NPC can be obscure due to its anatomic location. On the other hand, sinonasal undifferentiated carcinoma defined as a highly aggressive and clinicopathologically distinctive carcinoma of uncertain histogenesis that typically presents with locally extensive disease. The present report is a case of 66-year-old malay woman with underlying hypertension, hyperlipidemia and ischemic heart disease presented with swelling over the left upper palate for 5 months associated with the nasal symptoms. Cranial nerves were intact. Nasal endoscopy of the left nose revealed a mass occupying the left nasal cavity with histopathology of sinonasal undifferentiated carcinoma. However, CT scan result showed huge left nasopharyngeal carcinoma with local invasion and intracranial extension.

Computed tomography as a prime modality for early detection of nasopharyngeal carcinoma.

Objective: To determine the diagnostic accuracy of computed tomographic scan for the diagnosis of nasopharyngeal carcinoma, taking histopathology as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Radiology, Allied Hospital, Faisalabad. Period: 5th December 2020 to 4th June 2021. Material & Methods: Total 170 people between the ages of 20 and 60, of either gender, who were thought to have nasopharyngeal cancer were included. Patients with previous operation on the neck, previous radiotherapy to the neck, or patients with congenital lesions, claustrophobic and CRF were excluded. Then patients were undergone CT evaluation. Patients were labeled as positive or negative. Then patients were undergone biopsy and biopsy samples were evaluated from the Histopathology Department of Allied hospital Faisalabad. Biopsy results were followed and patients were confirmed as positive or negative. Results: Using histology as gold standard, computed tomographic scan has a sensitivity of 95.10%, specificity of 91.18%, positive predictive value of 94.17%, negative predictive value of 92.54%, and diagnostic accuracy of 93.53% for detecting NPC. Conclusion: This study proved computed tomography as a highly sensitive and accurate non-invasive modality for the detection of intracranial extension of NPC.

663 Squamous Cell Carcinoma of the Scalp Following Synthetic Hair Transplantation: A Case Report

Abstract Androgenetic alopecia is the most common form of hair loss. Surgical treatment options include autologous and synthetic hair transplantation. Synthetic hair fibres can overcome the challenges of poor hair quality and density however there are reports of severe cutaneous complications following their use. We report a case of an advanced squamous cell carcinoma (SCC) of the scalp in an adult male patient following chronic artificial hair transplants. The fungating mass eroded the inner cortex of the left parietal bone without intra-cranial extension on CT. Indeterminate lymph nodes in the parotid gland and level III of the left neck were identified on CT and MRI. Resection of the artificial hair fibres and SCC with a craniectomy, total parotidectomy with facial nerve preservation and upper neck dissection were performed. There was extensive dural involvement not detected on pre-operative imaging, which involved the superior sagittal sinus and was unresectable. The dural disease was fulgurated. The defect was reconstructed with a titanium plate and DIEP flap. Final histopathology showed a moderately differentiated pT4a N0 M0 SCC. The patient received adjuvant proton beam therapy and at 18 months post-operatively is recurrence free. Development of scalp SCC following synthetic hair transplantation has been described, although a clear causation has not been defined. Clinicians should be aware of this presentation and aim to achieve an early diagnosis, timely referral to an appropriate specialist and prompt management.

Non-surgical management of chronic granulomatous invasive fungal sinusitis with intracranial extension a case report and literature review

Chronic granulomatous invasive fungal sinusitis (CGIFS) is a rare manifestation of the heterogeneous disease process of fungal rhinosinusitis that is traditionally managed with some form of resective or debulking surgery. Historically, these were invasive transfacial resections. With the development of endoscopic surgery this treatment has become less invasive, but surgery still forms a major component of management. It is a rare disease that usually only occurs in dry subtropical areas. We describe the case of a female in her 30’s who presented with progressive headache and facial paresthesia. Workup demonstrated a large destructive lesion centred on the left sphenoid sinus invading the orbit and middle cranial fossa. The patient underwent urgent biopsies with a presumed diagnosis of an invasive malignancy. Upon identifying fungal organisms on culture the patient was commenced on anti-fungal treatment. We describe the first medically managed case of CGIFS with orbital and intracranial extension and perform a review of the contemporary literature to better understand this rare and challenging condition.

Contribution of Medical Imaging in the Diagnosis of Epidermoid Cyst of the Anterior Fontanel in an Child: A Case at the “Mother-Child" University Hospital Center (Chu) Bamako Luxembourg

This study aims to identify the epidemiological, clinical, radiological, surgical and histological characteristics of epidermoid cysts. The epidermoid cyst of the anterior fontanel is a very rare congenital lesion, less frequent than the dermoid cyst. We report a case of a four-month-old infant who consulted for a mass located at the level of the anterior fontanel. This lesion presented at birth as a small, soft mass covered with normal-looking scalp that gradually enlarged. Computed tomography showed the characteristics of a slightly heterogeneous cystic lesion limited by the superior sagittal sinus below, without intracranial extension. The surgical intervention allowed its ablation in one piece without adhesion. Histology confirmed the diagnosis. The evolution was satisfactory.

Triple whammy in pandemic: COVID-19, mucormycosis and myiasis

Mucormycosis is a fatal opportunistic fungal infection most commonly seen in immunocompromised individuals. The mortality can vary depending on the extent of the disease, starting in the paranasal sinuses, reaching the orbit, and eventually spreading intracranially. The sudden surge of Mucormycosis along with COVID-19 infections has rightfully been described as an epidemic amidst a pandemic. While the exact etiological factor is still being investigated, uncontrolled diabetes seems to be the most common inciting factor. Mucormycosis being angioinvasive, often leads to thrombus formation in the vessels, which leads to the necrosis of the tissues and bones, most commonly the maxilla. This necrotic tissue forms an ideal culture for various organisms and is a potential source for maggots' infestation. The presence of nasal myiasis further worsens the clinical status of the patients, making them prone to life-threatening complications. Thus, nasal myiasis seems to be an independent prognosticating factor in such cases. Here, we have described two such cases, our approach to management and mortality despite the best possible management.Two cases are being presented of elderly patients with comorbidities of type 2 diabetes mellitus and coronary artery disease. Both patients had a recent onset of COVID-19 and presented with intraorbital and intracranial disease extension along with nasal myiasis. Both patients succumbed to the fulminant pathology despite aggressive management.Mucormycosis, COVID-19 and nasal myiasis combine together to form a fatal triad, which despite early identification and aggressive management, carries a poor prognosis.

Magnetic resonance imaging in COVID-19-associated acute invasive fungal rhinosinusitis - Diagnosis and beyond.

The aim of the study was to evaluate the magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) at presentation and on follow-up imaging when patients receive treatment with systemic antifungal therapy and surgical debridement. This is a retrospective analysis of imaging data from a cohort of patients diagnosed with AIFRS during the second wave of COVID-19 in single tertiary referral hospital in South India between March 2021 and May 2021 (n = 68). Final diagnosis was made using a composite reference standard which included a combination of MRI findings, clinical presentation, nasal endoscopy and intraoperative findings, and laboratory proof of invasive fungal infection. Analysis included 62 patients with "Definite AIFRS" findings on MRI and another six patients with "Possible AIFRS" findings on MRI and laboratory proof of invasive fungal infection. Follow-up imaging was available in 41 patients. The most frequent MRI finding was T2 hypointensity in the sinonasal mucosa (94%) followed by mucosal necrosis/loss of contrast-enhancement (92.6%). Extrasinosal inflammation with or without necrosis in the pre-antral fat, retroantral fat, pterygopalatine fossa, and masticator space was seen in 91.1% of the cases. Extrasinosal spread was identified on MRI even when the computed tomography (CT) showed intact bone with normal extrasinosal density. Orbital involvement (72%) was in the form of contiguous spread from either the ethmoid or maxillary sinuses; the most frequent presentation being orbital cellulitis and necrosis, with some cases showing extension to the orbital apex (41%) and inflammation of the optic nerve (32%). A total of 22 patients showed involvement of the cavernous sinuses out of which 10 had sinus thrombosis and five patients had cavernous internal carotid artery involvement. Intracranial extension was seen both in the form of contiguous spread to the pachymeninges over the frontal and temporal lobes (25%) and intra-axial involvement in the form of cerebritis, abscesses, and infarcts (8.8%). Areas of blooming on SWI were noted within the areas of cerebritis and infarcts. Perineural spread of inflammation was seen along the mandibular nerves across foramen ovale in five patients and from the cisternal segment of trigeminal nerve to the root exit zone in pons in three patients. During follow-up, patients with disease progression showed involvement of the bones of skull base, osteomyelitis of the palate, alveolar process of maxilla, and zygoma. Persistent hyperenhancement in the post-operative bed after surgical debridement and resection was noted even in patients with stable disease. Contrast-enhanced MRI must be performed in all patients with suspected AIFRS as non-contrast MRI fails to demonstrate tissue necrosis and CT fails to demonstrate extrasinosal disease across intact bony walls. Orbital apex, pterygopalatine fossa, and the cavernous sinuses form important pathways for disease spread to the skull base and intracranial compartment. While cerebritis, intracranial abscesses, and infarcts can be seen early in the disease due to the angioinvasive nature, perineural spread and skull base infiltration are seen 3-4 weeks after disease onset. Exaggerated soft-tissue enhancement in the post-operative bed after debridement can be a normal finding and must not be interpreted as disease progression.

Use of patient-specific 3D printed models in pre-operative counseling for pediatric skull base surgery.

Pediatric cranial base pathology is anatomically complex and surgical treatment is oftentimes difficult to conceptualize for patients and their families. Three-dimensional (3D) models of the sinuses and cranial base have the potential to enhance patient understanding in numerous domains. Our objective is to assess the use of 3D models in pre-operative parental and patient counseling prior to endoscopic endonasal skull base surgery in the pediatric population. A survey was designed to assess parent and patient-perceived utility of 3D-printed models in surgical counseling prior to pediatric skull base surgery. A total of 10 patients were included. The median age was 9 years (range=5 months-15 years). Pathology included juvenile nasopharyngeal angiofibroma (JNA) (N=4), fibrous dysplasia of the maxilla and sphenoid (N=1), juvenile ossifying fibroma (N=1), nasal dermoid (N=2, one with intracranial extension), encephalocele (N=1), and parapharyngeal ectopic glial tissue (N=1). Nearly all parents agreed or strongly agreed that 3D printed models were helpful in explaining the patient's skull base pathology (N=10), surgical plan (N=10), and possible complications (N=9). All parents strongly agreed that 3D models should be used routinely in pre-operative counseling for endoscopic endonasal surgery. According to a majority of parents, patients older than 4 years old found the models helpful in understanding their pathology (75%) and surgery (88%). By allowing direct three-dimensional visualization of the target pathology, 3D models serve as a useful adjunct in enhancing patient comprehension of the pathologic entity, planned surgery, and potential complications prior to pediatric endoscopic endonasal skull base surgery.

Invasive Sinusitis Presenting with Orbital Complications in COVID Patients: Is Mucor the Only Cause?

The second wave of COVID pandemic was associated with an outbreak of Mucormycosis. The mortality rate of Mucormycosis reaches 50-80% in cases with orbital and intracranial extension (Fadda in Acta Otorhinolaryngol Ital 41:43-50, 2021). In this outbreak we found that few of these patients had bacterial invasive sinusitis mimicking fungal sinusitis. Amphotericin the only effective drug against Mucormycosis is highly toxic and expensive and not indicated in bacterial sinusitis. Our aim was to determine the exact etiologic agent, predisposing factors and outcome of treatment of COVID associated invasive sinusitis presenting with orbital complications. It is a retrospective observational study done in 33 patients with orbital complications in COVID associated invasive sinusitis. Demographic details of the patients and clinical presentation were documented. Rhinological examination was done and a nasal swab was taken for KOH mount along with Gram`s stain and Culture and Sensitivity. All Patients underwent radiological evaluation by contrast enhanced computed tomography (CECT) or MRI. Liposomal Amphotericin B was started. Surgical debridement done. Amphotericin-B was stopped in cases reported negative for fungal elements and antibiotics administered for two weeks. Outcome of treatmentwas documented. A total of 33 patients were included in the study. 48.5% patients were found to have bacterial infection and 27.3% patient's fungal infections and 24.2% mixed infections.Eschar formation, necrotic tissue, erosion of the lamina papyracea was seen in both Klebsiella (33.3%) and Staphylococcal infections (16.6%) similar to Mucor and mixed infections. Persistent opthalmoplegia and deterioration of vision was associated with Mucor and mixed infections. However improvement in proptosis, ptosis, ophthalmoplegia, and vision was observed in cases associated with bacterial invasive sinusitis. Invasive bacterial sinusitis was under diagnosed during second wave of COVID. Identification of invasive bacterial sinusitis can help in de-escalation of treatment.

Ossifying fibroma of mastoid: a case report

Ossifying fibroma is a slow growing benign neoplasm usually Involving bones of the skull and the face, mainly mandible and maxilla. The tumor is composed of bone that develops within fibrous connective tissue, sometimes with cementum-like calcifications. Clinical presentation is usually asymptomatic, rarely presented with facial asymmetry, swelling, pain, bowing of long bones. Radiological investigations are mainly computed tomography (CT) scan and magnetic resonance imaging (MRI). Ossifying fibroma very rarely can be seen as a tumor in temporal bone. In this case report 30-year-old male presented with a history of blocked ear and occasional left ear ache. On examination left externa auditory canal was narrow with bony prominence in the posterior canal wall. CT and MRI revealed left mastoid mass, during surgery hard vascular mass filling the mastoid antrum dissected out and histopathology confirmed as ossifying fibroma. The definitive treatment of ossifying fibroma is complete surgical excision. Complications can be local invasion, intracranial extension.

Epithelioid Hemangioendothelioma of the Mastoid Bone with Extension of Middle Cranial Fossa: A Case Report.

Epithelioid hemangioendothelioma (EHE) is a rare sarcoma of vascular origin. It is frequently seen in the liver, lungs and bones. Cases with mastoid bone and intracranial extension are rarer.A 40 year old male, presented with a history of progressive headaches and a mass in the postauricular region for a duration of three months. Computer tomography of the temporal bone showed an approximately 40 × 30mm soft tissue with osteolytic bony changes located in the mastoid bone.Epithelioid hemangioendothelioma is a rare sarcoma of vascular origin. Surgery is the first line of therapy. Prognosis is generally good, and may be better for primary intracranial disease than that for EHE originating elsewhere.

Surgical Management and Outcomes of Pediatric Congenital Head and Neck Teratomas: A Scoping Review.

To perform a scoping review to characterize postoperative outcomes of pediatric patients (ages 0-18) with a history of congenital head and neck teratomas. PubMed, EMBASE, Web of Science, Cochrane, Clinicaltrails.gov. A search of multiple databases was performed. Studies were included if they detailed the surgical management and outcomes of pediatric patients with a history of congenital head and neck teratomas. One hundred and eight studies totaling 137 patients were identified. The median gestational age at birth was 37 weeks. Respiratory distress, prompting emergent endotracheal intubation or tracheostomy, was present in most patients (58%). The ex utero intrapartum treatment (EXIT) procedure was utilized for 21 (15%) patients. The teratomas were resected after a median duration of 4 days from birth. The most common postsurgical complications were vocal cord paralysis (3%), hemorrhage (2%), and tracheomalacia (2%). Death occurred perioperatively in 2 patients (2%). Twenty-six patients (19%) required additional surgery, and 5 patients (4%) needed adjuvant chemotherapy. Patients were monitored for a median duration of 24 months with a recurrence rate of 6%. Four recurrent cases (50%) had intracranial extension, and 88% of the recurrent cases were mature teratomas at initial histopathological diagnosis. Most patients with congenital head and neck teratomas require emergent airway management perinatally. Excisional and surgical complications are rare, and most patients are cured of their disease with a single operation. Recurrent teratomas tend to have an intracranial extension and are likely to be of mature pathology at the time of initial diagnosis.

Primary Cranial Vault Lymphoma with Extra- and Intracranial Extension: A Case Report

Primary cranial vault lymphoma with extra- and intracranial extension in an immunocompetent patient is extremely rare. Given its rarity, the optimal management of this entity remains uncertain. We report an atypical case of a 21-year old immunocompetent man, who presented with an 8-month history of enlarging parieto-occipital mass. CT and MR imaging revealed a large mass with extra cranial and cranial components with sagittal sinus involvement. Unusually, angiography showed a significant tumor blush with large feeding vessels. After a pre surgical embolization, the patient underwent a complete tumor resection followed by radio and chemotherapy with satisfactory results.

The Necessity of Dural Resection for Nasal Dermal Sinus Cyst With Intracranial Extension.

Nasal dermal sinus cysts are characterized by an intracranial-extradural extension. Complete extirpation of nasofrontal dermoid sinus cysts is essential for effective treatment to minimize recurrence. The authors revealed the pathologic findings of the cranial end connected to the dura. In our case, the cranial end and dura were fibrous connective tissues that were difficult to separate. For complete extirpation of the nasal dermal sinus cyst with intracranial extension, the cranial ends of the nasofrontal dermoid sinus cyst and dura should be resected en bloc.

Pott's Puffy: First Shot is the Best Shot.

Low incidence of Pott's Puffy tumor (PPT) has caused studying risk factors and recurrences of the disease to be difficult. We used the comparatively increased incidence at our institution to evaluate potential risk factors for the disease process itself and prognostic factors for recurrence of the disease. Single institutional retrospective chart review identified 31 patients from 2010 to 2022 with PPT compared with a control group of 20 patients with either chronic rhinosinusitis or recurrent sinusitis. Patient mean age of PPT was 42 (range of 5 to 90) with the majority of the patient population as male (74%) and Caucasian (68%) in the setting of rural West Texas. Patient mean age of the control group was 50.7 (range of 30-78) with majority of patient population as male (55%) and Caucasian (70%). Interventions studied were functional endoscopic sinus surgery (FESS), FESS with trephination, and cranialization with or without FESS to compare prognostic factors for recurrence rates of PPT. These patients' prognostic risk factors for recurrence and risk factors to develop PPT were analyzed using Analysis of Variance (ANOVA) χ 2 statistical analysis with Fischer exact testing. Mean age was 42 years (range of 5-90) with the majority of the PPT patient population as male (74%) and Caucasian (68%) with an overall incidence of about 1 in 300,000. Pott's Puffy tumor patients were significantly favored in the younger and male population compared with the control patients. Risk factors of no prior allergy diagnosis, previous trauma, medication allergy to penicillin class or cephalosporin class, and lower body mass index were significant in the PPT population compared with the control group. Significant prognostic factors for recurrence of PPT were prior history of sinus surgery and operative treatment choice. Fifty percent (3/6) of patients with prior sinus surgery had recurrence of PPT. Of our 4 treatment options (FESS, FESS with trephination, FESS with cranialization, or cranialization alone), ;FESS had a recurrence of PPT of 0% (0/13), FESS with trephination had a recurrence of PPT of 50% (3/6), FESS with cranialization had a recurrence of PPT of 11% (1/9), and cranizalization alone had a recurrence of PPT of 0% (0/3). Of note, postop chronic rhinosinusitis was seen in 46% (6/13) of FESS alone, 17% (1/6) with FESS with trephination, 0% (0/9) with FESS with cranialization, and 33% (1/3) with just cranialization alone. Pott's Puffy tumor patients were younger and predominately male when compared to the control patients. No prior allergy diagnosis, previous trauma history, medication allergy to penicillin class or cephalosporin class, and lower body mass index are risk factors for PPT. There are 2 prognostic factors that predict recurrence of PPT: first operative treatment choice and prior sinus surgery. History of prior sinus surgery tends to increase the recurrence of PPT. The first operative treatment plan is the best shot at definitively treating PPT. Correct management surgically can prevent recurrence of PPT as well as long-term recurrence of chronic rhinosinusitis. With early diagnosis and mild disease, FESS is sufficient to prevent recurrence of PPT but chronic sinusitis may continue to occur if frontal sinus outflow track is not well opened. If considering trephination, a definitive cranialization may be more suited for more advanced disease since our study showed 50% of recurrence of PPT with trephination and FESS along with 17% chronic sinusitis long term. More advanced diseases with higher WBCs and intracranial extension do better with more aggressive surgical management with a cranialization with or without FESS which shows to reduce rates of PPT recurrence significantly.

Acute presentation of locally advanced squamous cell carcinoma of frontal sinus—imaging findings of a rare entity: case report

BackgroundThe squamous cell carcinoma is the most common subtype of malignant sinonasal tumours, predominantly involving the maxillary sinuses and nasal cavities in 70 to 80% of cases, and the frontal sinus is extremely rarely involved, in less than 1% of cases. Early clinical and radiological diagnosis is difficult due to overlap of findings with inflammatory sinonasal disease.Case presentationA 55-year-old Caucasian male patient had presented to the emergency department with three-month history of progressive right frontal swelling, acute frontal pain, recent exacerbation of right eye vision impairment and new lid swelling. There was no recent history of trauma and no neurological deficit on examination. Contrast-enhanced CT head was performed which demonstrated large bony destruction of frontal sinus with partly enhancing necrotic-looking tumour within the sinus. There was further intraorbital and intracranial extension of disease. Subsequent MRI confirmed these findings with better demonstration of intracranial and intraorbital component of the disease. The PET imaging did not reveal any avid disease elsewhere. Histopathology confirmed squamous cell carcinoma.ConclusionsFrontal sinus squamous cell carcinoma is a rare and the least common site within the paranasal sinuses. Early clinical and imaging diagnosis could be challenging; however, the index of suspicion should be high with indeterminate imaging findings. CT and MRI are the complimentary imaging techniques.

Clinicoepidemiological Study of Intracranial Extension of Rhino-Orbito-Cerebral Mucormycosis in a Tertiary Care Hospital

Clinicoepidemiological Study of Intracranial Extension of Rhino-Orbito-Cerebral Mucormycosis in a Tertiary Care Hospital

Imaging spectrum, associations and outcomes in acute invasive fungal rhino-ocular-cerebral sinusitis in patients with COVID-19 pneumonia.

Coronavirus Disease 2019 (COVID-19) has been speculated to enhance mucormycosis infection due to its immune-altering pathophysiology. Early identification of high-morbidity conditions is crucial for optimal treatment and improved outcomes. A retrospective study was conducted on 63 patients with clinical and microbiological evidence of rhino-ocular-cerebral mucormycosis, who had a history of COVID-19 infection. The clinical, demographic, and imaging data were retrieved and analyzed. Descriptive statistics (mean [SD] and frequency [%]) were used to describe important characteristics across audit cycles. Out of 63 patients, 54 (85.71%) patients had associated comorbidities, with diabetes mellitus being common comorbidity and all patients had received injectable and/or oral corticosteroids. Imaging showed nasal and paranasal sinus, perisinus, maxillary alveolar arch, and hard palate involvement in 62 (98.41%), 33 (52.38%), 5 (7.94%) and 5 (7.94%) patients, respectively. Orbital involvement was seen in 24 (38.10%) patients. Skull base involvement was seen in 11 (17.46%) patients, and intracranial extension of disease was present in 11 (17.46%) patients. A total of 16 patients were on mechanical ventilation, of whom 3 succumbed. The mean (standard deviation [SD]) intensive care unit (ICU) stay was 13.2 days (6.8) for 5 patients who succumbed and 6.4 days (4.6) for 30 patients who survived (P value = 0.008). Cross-sectional imaging not only provides the extent of disease spread but also plays a vital role in providing a surgical roadmap to treating surgeons and in predicting prognosis in patients with invasive fungal infections.