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J Neurol Surg B Skull Base
DOI: 10.1055/a-2706-1268
Original Article

Does Debridement of Intracranial Disease in Acute Invasive Fungal Sinusitis Improve Survival?

Authors

  • Alice E. Huang 

    1   Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States

  • Christine K. Lee

    2   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States

  • Jayakar V. Nayak

    1   Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States

  • Peter H. Hwang

    1   Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States

  • Zara M. Patel 

    1   Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States

  • Juan C. Fernandez-Miranda

    1   Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
    2   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States

  • Michael T. Chang 

    1   Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States

Funding Information Internal departmental funding was utilized without commercial sponsorship or support.
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Abstract

Background

Intracranial (IC) extension is a poor prognostic factor for acute invasive fungal sinusitis (IFS). There are no studies on the role of IC debridement in the setting of rhinocerebral IFS.

Methods

We retrospectively reviewed patients with rhinocerebral IFS confirmed on imaging who underwent surgical management. Patients who underwent sinonasal debridement only (reference group) were compared with those who underwent sinonasal and IC debridement (IC group). The primary outcome was overall survival. Univariate analysis and logistic regression were performed to assess for differences in clinical characteristics between the treatment groups and predictive factors of survival.

Results

Twenty-nine patients were included in the study, with 10 patients in the IC group and 19 patients in the reference group. There were no significant differences in patient demographics or predisposing conditions between the groups. Regarding IC extent of fungal disease, there were no significant differences in rates of dural, leptomeningeal, or parenchymal involvement; cavernous sinus extension; or cisternal cranial nerve involvement. The IC group had significantly more IC abscesses (60%) than the reference group (5%, p = 0.002). At the time of the most recent follow-up (month, year), 30% (n = 3) of the IC group, and 79% (n = 15) of the reference group had died (p = 0.02). The Cox proportional hazards model demonstrated a 93% reduction in the risk of death with IC debridement when adjusting for all covariables (p = 0.004).

Conclusion

This study is the largest series to examine neurosurgical management of rhinocerebral IFS, demonstrating possible survival benefit with IC debridement in select patients and with highly specialized surgical expertise.

Keywords

invasive fungal sinusitis - skull base surgery - endoscopic sinus surgery

Note

This work was previously presented in ISIAN and IRS 2024, Tokyo, Japan; April 4 to 6, 2024.


Supplementary Material



Publication History

Received: 07 April 2025

Accepted: 18 September 2025

Article published online:
09 October 2025

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