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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
09:53

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Published on: July 5, 2021

Invasive rhino-cerebral fungal granuloma

Muralimohan Selvam1, Anil Pande, Vasudevan M Chakravarthy

  • 1Department of Neurosurgery, Postgraduate Institute of Neurological Surgery, ALNC, VHS Medical Centre, Taramani, Chennai - 600 113, India. drmurali78@gmail.com

Neurology India
|May 29, 2010
PubMed
Abstract

Insights

Complete surgical removal and antifungal treatment significantly improve outcomes for skull base fungal granuloma. This approach enhances progression-free survival (PFS) in patients with this challenging central nervous system infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Surgical Oncology

Background:

  • Global increase in fungal infections, particularly challenging central nervous system (CNS) cases.
  • Skull base fungal granuloma requires intensive, multi-modality treatment strategies.
  • Diabetes mellitus identified as a significant predisposing factor.

Purpose of the Study:

  • To evaluate the efficacy of surgical intervention and antifungal therapy for skull base fungal granuloma.
  • To determine factors influencing progression-free survival (PFS) and overall outcomes.
  • To analyze treatment outcomes based on surgical extent and antifungal regimen.

Main Methods:

  • Retrospective analysis of 33 patients with skull base fungal granuloma treated between 1988-2008.
  • Staging of granuloma extent using neuroimaging, operative findings, and follow-up data.
  • Assessment of outcomes based on surgical approach (total vs. subtotal excision) and antifungal therapy (Amphotericin).

Main Results:

  • Thirty-three patients underwent surgical treatment; mean age was 33.2 years.
  • Eight patients (24%) expired within two months post-surgery due to disease flare-up.
  • Grossly total excision correlated with a mean PFS of 43 months, versus 23 months for subtotal excision.

Conclusions:

  • Total surgical excision combined with a complete course of antifungal therapy is crucial for improving PFS.
  • The development of less toxic, highly efficacious, fungicidal antifungal agents could further enhance patient outcomes.
  • Optimizing treatment strategies is essential for managing this difficult-to-treat CNS fungal infection.

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