Invasive rhino-cerebral fungal granuloma.
BACKGROUND
Increased incidence of fungal infection has been reported globally in the recent years. Fungal infection of the central nervous system remains one of the most difficult diseases to treat and requires multi-modality intensive therapeutic strategies.


METHODS
Retrospective analysis of case records of patients with confirmed skull base fungal granuloma treated at a tertiary hospital between 1988-2008. An attempt was made to stage the extent of skull base fungal granuloma based on neuroimaging, operative findings and course of the disease on serial follow-up.


RESULTS
Thirty-three patients with skull base fungal granuloma were treated surgically during the study period. The mean age at presentation was 33.2 years and diabetes was a major predisposing factor. Eight patients expired in the first two months following surgical intervention due to flare-up of the disease. Eighteen patients who underwent grossly total excision had a mean progression-free survival (PFS) of 43 months and seven patients with subtotal excision had a mean PFS of 23 months. Better survival probability was noted in those patients who underwent total excision at surgery and received complete course of amphotericin.


CONCLUSIONS
Total surgical excision with complete course of antimycotic drug therapy increases PFS. A better antimycotic drug with less toxicity and high efficacy with fungicidal property can make a difference in the outcomes of the disease.
Selvam
Muralimohan
M
Department of Neurosurgery, Postgraduate Institute of Neurological Surgery, ALNC, VHS Medical Centre, Taramani, Chennai - 600 113, India. drmurali78@gmail.com
Pande
Anil
A
Chakravarthy
Vasudevan M
VM
Ramamurthi
Ravi
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D020314:Central Nervous System Fungal Infections / Q000150:complications / Q000601:surgery*; D003920:Diabetes Mellitus / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000150:complications / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult