Isolated Acute Sphenoid Fungal Sinusitis with Cavernous Sinus Thrombosis: Our Experience
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ORIGINAL ARTICLE
Isolated Acute Sphenoid Fungal Sinusitis with Cavernous Sinus Thrombosis: Our Experience Amit Kumar1 Niraj Kumar2
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Kartikesh Gupta1
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Amit Kumar Tyagi1
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Saurabh Varshney1
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Received: 7 July 2020 / Accepted: 12 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be
& Kartikesh Gupta [email protected] Amit Kumar [email protected] Amit Kumar Tyagi [email protected] Saurabh Varshney [email protected] Niraj Kumar [email protected] 1
Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201, India
2
Department of Neurology, All India Institue of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201, India
saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite nonconclusive imaging, is warranted as early intervention may significantly impact the chances of survival. ‘‘Time is vision’’ in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. ‘‘time is muscle. Keywords Cavernous sinus thrombosis Sphenoid sinusitis Fungus Aspergillosis Mucormycosis
Introduction Isolated lesions of the sphenoid sinus are uncommon. Proximity of sphenoid sinus with important structures like cavernous sinus, internal carotid artery, cranial nerves, pituitary gland and its posterior location often make the diagnosis and treatment difficult. Incidence of fungal sinusitis in isolated sphenoid disease is 4–27% [1–3]. Most common symptom in Isolated Acute Sphenoid Fungal Rhinosinusitis (IASFRS) is either headache or visual symptoms [1, 4–6]. IASFRS is difficult to diagnose early when patient presents with nonspecific symptoms like facial pain, numbness or headache. Ocular symptoms in IASFRS are due to cavernous sinus thrombosis or orbital apex syndrome in an advanced disease process [5]. We present 5 cases of IASFRS who presented to us with features of cavernous sinus thrombosis. Patients were worked up as emergency cases and urgent debridement with endoscopic sinus sur
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