Related Experiment Videos
Skull base erosion by sphenoid fungus balls: diagnosis and endoscopic treatment
Rodney J Schlosser1, Charles W Gross, Stilianos Kountakis
1Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, USA.
Background:
Fungus balls typically are innocuous lesions found in immunocompetent hosts. They are located most commonly in the maxillary sinus but may be life-threatening when found in the sphenoid sinus.
Methods:
We review our series offour sphenoid fungus balls with skull base erosion.
Results:
Our average patient age was 68.7 years old (56-86 years) with three women and one man. One patient was insulin-dependent diabetic, the other three patients were otherwise healthy. The most common presenting symptoms were headache and dizziness with relatively few sinus-specific complaints. Endoscopy revealed polyps in two of the four patients. Computerized tomography scans revealed thickened osteitic bone in three cases and two of the four computed tomography scans showed microcalcification. All patients had bony erosion over the internal carotid arteries. Additionally, one patient internal carotid artery thrombosis, one patient had erosion of the planum sphenoidale, and a third patient had erosion to the brainstem inferior to the sella turcica. Three patients had magnetic resonance imaging that revealed heterogeneous lesions. Two magnetic resonance images showed hypointense T1 and T2 imaging. The third was isointense on T1 and hypointense on T2. All patients were treated with endoscopic marsupialization and removal of all gross fungal debris without complications. All pathological specimens were diagnostic for fungus balls. One offour cultures was positive for fungus. All patients are asymptomatic at time of lastfollow-up.
Conclusions:
Sphenoid fungus balls present with vague, non-rhinological symptoms, but may have significant local expansion and destruction. These potentially lethal lesions usually can be suspected on preoperative imaging and are best treated with endoscopic removal.
Insights
Sphenoid fungus balls, though rare, can cause serious skull base erosion. Endoscopic removal is an effective treatment, leading to asymptomatic recovery.
Area of Science:
- Otolaryngology
- Neurosurgery
- Radiology
Background:
- Fungus balls are typically benign sinus lesions in immunocompetent individuals.
- While commonly found in the maxillary sinus, they can be life-threatening in the sphenoid sinus.
Purpose of the Study:
- To review a series of four sphenoid fungus balls presenting with skull base erosion.
- To highlight the clinical presentation, imaging findings, and treatment outcomes.
Main Methods:
- Retrospective review of four cases of sphenoid fungus balls with skull base erosion.
- Analysis of patient demographics, symptoms, endoscopic findings, and imaging (CT, MRI).
Main Results:
- Patients (average age 68.7) presented with non-specific symptoms like headache and dizziness.
- Imaging revealed bony erosion, thickened osteitic bone, and microcalcification in several cases.
- All patients underwent successful endoscopic marsupialization and fungal debris removal, with no complications.
Conclusions:
- Sphenoid fungus balls can cause significant local destruction and present with vague symptoms.
- Preoperative imaging is crucial for suspecting these potentially lethal lesions.
- Endoscopic removal is the preferred treatment, leading to favorable outcomes.