A successful combined endovascular and surgical treatment of a cranial base mucormycosis with an associated internal carotid artery pseudoaneurysm.
OBJECTIVE
We report a rare case of internal carotid artery pseudoaneurysm owing to rhinocerebral mucormycosis and review 40 reported cases from 1980 to present.


METHODS
A 38-year-old Caucasian man presented with a 3-day history of headache, diplopia, and numbness in the distribution of the left ophthalmic and maxillary branches of the trigeminal nerve. A complete left cavernous syndrome was discovered upon neurological examination. Magnetic resonance imaging scans revealed an inflammatory process involving the paranasal sinuses with extension into the left cavernous sinus, temporal fossa, and petrous bone.


METHODS
The patient was immediately treated with amphotericin B, atorvastatin, and daily hyperbaric oxygen sessions before surgical intervention. The patient underwent endovascular treatment of the associated mycotic pseudoaneurysm after carotid test occlusion in addition to a radical bilateral debridement of the paranasal sinuses and infratemporal and temporal fossa.


CONCLUSIONS
Aggressive multimodal therapy is imperative for late-stage rhinocerebral mucormycosis. Extensive resection of infected tissue combined with amphotericin B, atorvastatin, and hyperbaric oxygen seems to be the best course of management. If the internal carotid artery is involved, endovascular intervention is clearly an option to attain this goal. Further research and longer follow-up periods are required to better understand the long-term implications of endovascular coiling and hyperbaric oxygen therapy for rhinocerebral mucormycosis.
Alvernia
Jorge E
JE
Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA. jalvernia@yahoo.com
Patel
Raj N
RN
Cai
David Z
DZ
Dang
Nguyen
N
Anderson
Dwayne W
DW
Melgar
Miguel
M
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D020212:Carotid Artery Injuries / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D003646:Debridement / Q000379:methods; D006801:Humans; D006931:Hyperbaric Oxygenation; D008279:Magnetic Resonance Imaging; D008297:Male; D009091:Mucormycosis / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010254:Paranasal Sinus Diseases / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D010256:Paranasal Sinuses / Q000382:microbiology / Q000473:pathology; D019291:Skull Base / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D013701:Temporal Bone / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D020433:Trigeminal Nerve Diseases / Q000382:microbiology / Q000503:physiopathology; D014656:Vascular Surgical Procedures / Q000379:methods
D000935:Antifungal Agents