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Skull base erosion and associated complications in sphenoid sinus fungal balls
Josh C Meier1, George A Scangas, Aaron K Remenschneider
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boson, Massachusetts, USA.
Background:
Sphenoid sinus fungal balls (SSFB) are rare entities that can result in serious orbital and intracranial complications. There are few published reports of complications that result from SSFB.
Objective:
To review the incidence of skull base erosion and orbital or intracranial complications in patients who present with SSFB.
Methods:
A retrospective review was performed of all the patients with SSFB who were treated at the Massachusetts Eye and Ear Infirmary from 2006 to 2014. Presenting clinical data, radiology, operative reports, pathology, and postoperative course were reviewed.
Results:
Forty-three patients with SSFB were identified. Demographic data were compared between patients with (39.5%) and those without (61.5%) skull base erosion. Two patients underwent emergent surgery for acute complications of SSFB (one patient with blindness, one patient who had a seizure). Both patients with acute complications had evidence of skull base erosion, whereas no patients with an intact skull base developed an orbital or intracranial complication (p = 0.15). All the patients were surgically managed via an endoscopic approach.
Conclusion:
SSFBs are rare but may cause significant skull base erosion and potentially severe orbital and intracranial complications if not treated appropriately. Endoscopic sphenoidotomy is effective in treating SSFB and should be performed emergently in patients who presented with associated complications.
Insights
Sphenoid sinus fungal balls (SSFB) can cause serious complications, including skull base erosion. Early endoscopic treatment is crucial for patients with SSFB, especially those with acute complications.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Diseases
Background:
- Sphenoid sinus fungal balls (SSFB) are uncommon but can lead to severe orbital and intracranial issues.
- Published reports on SSFB complications are limited.
Purpose of the Study:
- To determine the incidence of skull base erosion.
- To review orbital and intracranial complications in patients with SSFB.
Main Methods:
- Retrospective review of 43 patients with SSFB treated between 2006 and 2014.
- Analysis of clinical data, radiology, operative reports, pathology, and postoperative course.
Main Results:
- Skull base erosion was present in 39.5% of patients.
- Two patients experienced acute complications (blindness, seizure), both with skull base erosion.
- No patients with an intact skull base developed orbital or intracranial complications.
Conclusions:
- SSFBs, though rare, can cause significant skull base erosion and severe complications.
- Endoscopic sphenoidotomy is an effective treatment for SSFB.
- Emergent endoscopic intervention is recommended for SSFB patients with complications.
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