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Allergic fungal sinusitis with cranial base erosion
Author(s) -
Kinsella John B.,
Rassekh Christopher H.,
Bradfield Joseph L.,
Chaljub Gregory,
McNees Sandra W.,
Gourley William K.,
Calhoun Karen H.
Publication year - 1996
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/(sici)1097-0347(199605/06)18:3<211::aid-hed1>3.0.co;2-2
Subject(s) - medicine , surgery , skull , sinusitis , craniotomy , bone erosion , complication , rheumatoid arthritis
Background Allergic fungal sinusitis (AFS) usually follows a slow, nonaggressive course. However, massive bone destruction can occur, with extension of the disease process outside of the confines of the sinuses. Methods Our series of 28 cases of AFS was reviewed. We identified 6 cases of AFS with definite radiographic evidence of skull base erosion. Results Histologic diagnostic criteria for AFS were present in all 6 cases. All patients were managed with surgery, most recently conservative endoscopic surgery. An earlier patient underwent dural resection. Antibiotics were used in all patients, but no antifungal agents were administered. No patient has had a permanent neurologic complication, although one was seen with abducens palsy. There have been no cerebrospinal fluid (CSF) leaks. All 6 cases also had orbital bone erosion, but none has had permanent ophthalmologic sequelae. All patients were initially suspected to have a neoplastic disease. Conclusions We propose a new diagnostic entity, “skull base allergic fungal sinusitis” (SBAFS), which incorporates the histologic diagnostic criteria of AFS with the computed tomographic (CT) criteria of bone erosion. Biopsy is necessary to rule out invasive fungus or tumor. Otolaryngologists, ophthalmologists, and neurosurgeons should be familiar with SBAFS so that systemic antifungal agents, craniotomy, and dural resection—which might initially appear necessary—can be avoided. Endoscopic surgical debridement and drainage combined with topical steroids can lead to resolution of disease, even in the presence of marked bone erosion and cranial neuropathy. © 1996 John Wiley & Sons, Inc.