Document Detail


A successful combined endovascular and surgical treatment of a cranial base mucormycosis with an associated internal carotid artery pseudoaneurysm.
MedLine Citation:
PMID:  19834379     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We report a rare case of internal carotid artery pseudoaneurysm owing to rhinocerebral mucormycosis and review 40 reported cases from 1980 to present. CLINICAL PRESENTATION: A 38-year-old Caucasian man presented with a 3-day history of headache, diplopia, and numbness in the distribution of the left ophthalmic and maxillary branches of the trigeminal nerve. A complete left cavernous syndrome was discovered upon neurological examination. Magnetic resonance imaging scans revealed an inflammatory process involving the paranasal sinuses with extension into the left cavernous sinus, temporal fossa, and petrous bone. INTERVENTION: The patient was immediately treated with amphotericin B, atorvastatin, and daily hyperbaric oxygen sessions before surgical intervention. The patient underwent endovascular treatment of the associated mycotic pseudoaneurysm after carotid test occlusion in addition to a radical bilateral debridement of the paranasal sinuses and infratemporal and temporal fossa. CONCLUSION: Aggressive multimodal therapy is imperative for late-stage rhinocerebral mucormycosis. Extensive resection of infected tissue combined with amphotericin B, atorvastatin, and hyperbaric oxygen seems to be the best course of management. If the internal carotid artery is involved, endovascular intervention is clearly an option to attain this goal. Further research and longer follow-up periods are required to better understand the long-term implications of endovascular coiling and hyperbaric oxygen therapy for rhinocerebral mucormycosis.
Authors:
Jorge E Alvernia; Raj N Patel; David Z Cai; Nguyen Dang; Dwayne W Anderson; Miguel Melgar
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  65     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2010-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  733-40; discussion 740     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA. jalvernia@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Antifungal Agents / therapeutic use
Carotid Artery Injuries / microbiology,  pathology,  surgery*
Cavernous Sinus / microbiology,  pathology,  surgery
Cranial Fossa, Middle / microbiology,  pathology,  surgery
Debridement / methods
Humans
Hyperbaric Oxygenation
Magnetic Resonance Imaging
Male
Mucormycosis / complications*,  pathology,  surgery*
Neurosurgical Procedures / methods*
Paranasal Sinus Diseases / complications*,  microbiology,  pathology
Paranasal Sinuses / microbiology,  pathology
Skull Base / microbiology,  pathology,  surgery*
Temporal Bone / microbiology,  pathology,  surgery
Treatment Outcome
Trigeminal Nerve Diseases / microbiology,  physiopathology
Vascular Surgical Procedures / methods
Chemical
Reg. No./Substance:
0/Antifungal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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