Long-term survival of a patient with invasive cranial base rhinocerebral mucormycosis treated with combined endovascular, surgical, and medical therapies: case report.
OBJECTIVE
Rhinocerebral mucormycosis is a clinical syndrome resulting from an opportunistic infection caused by a fungus of the order Mucorales. The prognosis of rhinocerebral mucormycosis, once considered uniformly fatal, remains poor. Even with early diagnosis and aggressive surgical and medical therapy, the mortality rate is high. We present a patient with rhinocerebral mucormycosis involving the paranasal sinuses and cranial base who experienced long-term survival after multimodality treatment. Clinical characteristics of the disease are discussed, and the literature is reviewed.


METHODS
A 24-year-old diabetic man presented with invasive rhinocerebral mucormycosis involving the paranasal sinuses, right middle fossa, and right cavernous sinus.


METHODS
The patient underwent endovascular sacrifice of the involved carotid artery and radical resection of the cranial base, including exenteration of the cavernous sinus. Reconstruction with a local muscle flap was performed. He continued to receive intravenous and intrathecal administration of antibiotics.


CONCLUSIONS
Long-term survival with invasive rhinocerebral mucormycosis is rare, but possible, with aggressive multimodality treatment, including carotid sacrifice for en bloc resection of the pathology, when indicated.
Alleyne
C H
CH
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA.
Vishteh
A G
AG
Spetzler
R F
RF
Detwiler
P W
PW
D000328:Adult; D000900:Anti-Bacterial Agents; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009091:Mucormycosis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012852:Sinusitis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D019291:Skull Base / Q000473:pathology / Q000601:surgery*
D000900:Anti-Bacterial Agents