Abstract
The progress in the understanding of central nervous system (CNS) and skull base infections, is tremendous and it is more so in the case of fungal infections of CNS and skull base, especially cavernous sinus (CS) fungal infection. Available diagnostic tools and appropriate management protocol are continuously changing towards the better management of the fungal infection of CS. CS fungal lesions usually spread from surrounding the paranasal sinuses (PNS) and from the orbit. So understanding the pathology and pathologenesis is vital in the management of such dangerous infections. Management of CS fungal infection is not straightforward and rather complicated due to the underlying immunodeficiency in most of the patients. Treatment is mainly surgical with antifungal drug therapy. For ease of discussion in this chapter, brief anatomy of CS, etiopathogenesis of CS fungal infection, clinical presentation, radiological findings, and management with some special condition/complications of CS fungal infection including prevention will be discussed briefly.
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Abbreviations
- CNS:
-
Central nervous system
- CS:
-
Cavernous sinus
- CST:
-
Cavernous sinus thrombosis
- CT:
-
Computed tomography
- CTA:
-
Computed tomographic angiogram
- DSA:
-
Digital subtraction angiography
- EC-IC:
-
Extracranial-intracranial
- FLAIR:
-
Fluid attenuated inversion recovery
- ICA:
-
Internal carotid artery
- MCA:
-
Middle cerebral artery
- MRA:
-
Magnetic resonance angiogram
- MRI:
-
Magnetic resonance imaging
- PNS:
-
Paranasal sinuses
References
Abdulrauf SI. Extracranial-to-intracranial bypass using radial artery grafting for complex skull base tumors: technical note. Skull Base. 2005;15:207–13.
Aribandi M, McCoy V, Bazan C. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 2007;27:1283–96.
Bray WH, Giangiacomo J, Ide CH. Orbital apex syndrome. Surv Ophthalmol. 1987;32(2):136–40.
Chan LL, Singh S, Jones D, et al. Imaging of mucormycosis skull base osteo-myelitis. AJNR Am J Neuroradiol. 2000;21:828–31.
Choi HS, Choi JY, Yoon JS, Kim SJ, Lee SY. Clinical characteristics and prognosis of orbital invasive aspergillosis. Ophthal Plast Reconstr Surg. 2008;24:454–9.
Chowdhury F, Haque M, Kawsar K, Ara S, Mohammod Q, Sarker MH, Goel A. Transcranial microsurgical and endoscopic endonasal cavernous sinus (CS) anatomy: a cadaveric study. J Neurol Surg A. 2012;73:296–306.
Couldwell WT, Macdonald JD, Taussky P. Complete resection of the cavernous sinus-indications and technique. World Neurosurg. 2014;82:1264–70.
Devèze A, Facon F, Latil G, Moulin G, Payan-Cassin H, Dessi P. Cavernous sinus thrombosis secondary to non-invasive sphenoid aspergillosis. Rhinology. 2005;43(2):152–5.
Fairley C, Sullivan TJ, Bartley P, et al. Survival after rhino-orbital cerebral mucormycosis in an immunocompetent patient. Ophthalmology. 2000;107:555.
Ferry AP. Cerebral mucormycosis (phycomycosis). Ocular findings and review of the literature. Surv Ophthalmol. 1961;6:1.
Goldberg AL, Tievsky AL, Jamshidi S. Wegener’s granulomatosis invading the cavernous sinus: a CT demonstration. J Comput Assist Tomogr. 1983;7:701–3.
Haber DM, Fernandes AM, Neto DDS, Schiavetto RR. Rhino-orbitocerebral mucormycosis associated with cavernous sinus thrombosis: case report. Int Arch Otorhinolaryngol. 2008;12(4):574–8.
Hase T, Kurita H, Matsumoto E, Kuroda H, Hashimoto M, Shinoda S. A case of cavernous sinus aspergillosis. No Shinkei Geka. 2013;41(10):901–6.
Kalani MY, Kalb S, Martirosyan NL, Lettieri SC, Spetzler RF, Porter RW, et al. Cerebral revascularization and carotid artery resection at the skull base for treatment of advanced head and neck malignancies. J Neurosurg. 2013;118:637–42.
Lawton MT, Spetzler RF. Internal carotid artery sacrifice for radical resection of skull base tumors. Skull Base Surg. 1996;6:119–23.
Lee JH, Lee HK, Park JK, Choi CG, Suh DC. Cavernous sinus syndrome: clinical features and differential diagnosis with MR imaging. AJR Am J Roentgenol. 2003;181:583–90. https://doi.org/10.2214/ajr.181.2.1810583.
Mandava P, Chaljub G, Patterson K, et al. MR imaging of cavernous sinus invasion by mucormycosis: a case study. Clin Neurol Neurosurg. 2001;103:101–4.
Mauriello JA Jr, Yepez N, Mostafavi R, Barofsky J, Kapila R, Baredes S, et al. Invasive rhinosino-orbital aspergillosis with precipitous visual loss. Can J Ophthalmol. 1995;30:124–30.
McGinn JD, Isaacson JE, Scurry WC, Cheung EJ. Cavernous sinus thrombosis secondary to allergic fungal sinusitis. Rhinology. 2009;47-51:105–8.
Mendelowitsch A, Taussky P, Rem JA, Gratzl O. Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery. Acta Neurochir (Wien). 2004;146:95–101.
Nadkarni T, Goel A. Aspergilloma of the brain: an overview. J Postgrad Med. 2005;51(Suppl S1):37–41.
Neil JA, Orlandi RR, Couldwell WT. Malignant fungal infection of the cavernous sinus: case report. J Neurosurg. 2016;124:861–5. https://doi.org/10.3171/2015.2.JNS142668.
Ng BHK, Kho GS, Sim SK, Liew DNS, Tang IP. Cavernous sinus fungal infection: a rare case. Br J Neurosurg. 2017:1–2. https://doi.org/10.1080/02688697.2017.1335857. Accessed 09 Jun 2017
Ohta S, Nishizawa S, Namba H, et al. Bilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia: case report. J Neurosurg. 2002;96:600–2.
Pagliani L, Campi L, Cavallini GM. Orbital actinomycosis associated with painful ophthalmoplegia: actinomycosis of the orbit. Ophthalmologica. 2006;220:201–5.
Parikh SL, Venkatraman G, DelGaudio JM. Invasive fungal sinusitis: a 15-year review from a single institution. Am J Rhinol. 2004;18:75–81.
Paulltauf A. Mycosis mucorina. Virchows Arch. 1885;102:543–9.
Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004;10(suppl 1):31.
Rao SP, Kumar KR, Rokade VR, Khanna V, Pal C. Orbital apex syndrome due to mucormycosis caused by Rhizopus microsporum. Indian J Otolaryngol Head Neck Surg. 2006;58(1):83–8.
Razek AA, Castillo M. Imaging lesions of the cavernous sinus. AJNR Am J Neuroradiol. 2009;30(3):444–52. https://doi.org/10.3174/ajnr.A1398.
Shah NJ, Rathore A. Intracranial extension of fungal sinusitis. Otorhinolaryngol Clin. 2009;1(1):55–61.
Sivak-Callcott JA, Livesley N, Nugent RA, Rasmussen SL, Saeed P, Rootman J. Localised invasive sino-orbital aspergillosis: characteristic features. Br J Ophthalmol. 2004;88:681–7.
Stringer SP, Ryan MW. Chronic invasive fungal rhinosinusitis. Otolaryngol Clin N Am. 2000;33:375–87.
Tang Y, Booth T, Steward M, Solbach T, Wilhelm T. The imaging of conditions affecting the cavernous sinus. Clin Radiol. 2010;65:937–45.
Taussky P, Couldwell W. Decision-making strategies for EC-IC bypass in the treatment of skull base tumors. In: Abdelrauf SI, editor. Cerebral revascularization: techniques in extracranial-to-intracranial bypass surgery. Philadelphia: Saunders; 2010. p. 349–54.
Thompson GR, Patterson TF. Fungal disease of the nose and paranasal sinuses. J Allergy Clin Immunol. 2011;129:321–6.
Van Johnson E, Kline LB, Julian BA. Bilateral cavernous sinus thrombosis due to mucormycosis. Arch Ophthalmol. 1988;106(8):1089–92.
Vazquez L. Antifungal prophylaxis in immunocompromised patients. Mediterr J Hematol Infect Dis. 2016;8(1):e2016040. https://doi.org/10.4084/MJHID.2016.040.
Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. 1994;39(1):3–22.
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Chowdhury, F.H., Haque, M.R., Hossain, M.Z., Sarker, M.H. (2019). Cavernous Sinus Syndrome. In: Turgut, M., Challa, S., Akhaddar, A. (eds) Fungal Infections of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-030-06088-6_24
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