title: Sphenoid sinus fungus ball: our experience.
abstract: BACKGROUND
  Fungal rhinosinusitis is a common disease of the paranasal sinuses. The fungus ball (FB) is defined as an extramucosal mycotic proliferation that fills one or more paranasal sinuses. Sphenoid sinus is an uncommon localization of this disease, as reported in the literature. This study describes our experience in the diagnosis and treatment of sphenoid sinus FB (SSFB), with a particular focus on the surgical approach to the sphenoid sinus.
  
  
  METHODS
  We retrospectively analyzed the clinical records of patients affected by FB of the sphenoid sinus, who underwent endoscopic sinus surgery (ESS) in our institutions between 1995 and 2009. We described the surgical technique, the methods of mycological and histopathological evaluation, as well as the perioperative and postoperative management.
  
  
  RESULTS
  From 1995 to 2009, 226 patients affected by sinonasal FB underwent ESS in our institutions. A sphenoid localization was found in 56 patients (24.78%; mean age, 62 years). Cephalea was the most common symptom, and 14.3% of patients complained of ocular symptoms. We performed a direct paraseptal sphenoidotomy in 31 patients (55.4%) and a transethmoidal sphenoidotomy in 25 patients (44.6%). Histology unveiled fungal hyphae with absent mucosal invasion in all cases. Cultural results revealed positivity for mycotic colonization in 26 cases (46.4%, most commonly Aspergillus fumigatus). Follow-up ranged from 12 to 181 months with a mean of 70.7 months.
  
  
  CONCLUSIONS
  The description of our experience in the diagnosis and treatment of SSFB underlines the importance of a precise diagnostic pathway in case of sphenoidal disease. Nowadays, in our opinion, the paraseptal direct sphenoidotomy represents the less invasive, fastest and most anatomically conservative approach to the sphenoid sinus in case of SSFB.
authors.affiliation: Department of Otorhinolaryngology, Laboratori Sperimentali di Ricerca, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy. tpagella@libero.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Pagella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pusateri
authors.forename: Elina
authors.initials: E
authors.lastname: Matti
authors.forename: Georgios
authors.initials: G
authors.lastname: Giourgos
authors.forename: Caterina
authors.initials: C
authors.lastname: Cavanna
authors.forename: Francesca
authors.initials: F
authors.lastname: De Bernardi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bignami
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001232:Aspergillus fumigatus / Q000472:pathogenicity / Q000502:physiology*; D048708:Cell Growth Processes; D004724:Endoscopy; D005260:Female; D006261:Headache; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012852:Sinusitis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome