Non-randomized comparison of surgical modalities for paranasal sinus mycoses with intracranial extension

Mycotic infections of paranasal sinuses are frequently reported in southern Asia. Aspergillus and Mucor species are the predominant ones. Intracranial extension of paranasal sinus mycoses is a difficult problem to manage. We report 18 cases of paranasal sinus mycoses with intracranial extension. The commonest manifestations were nasal discharge (67%), nasal obstruction (50 %), ocular symptoms such as proptosis (44%), telecanthus (39%) and ophthalm oplegia. Computerized tomography scans were found to be quite informative r egarding the nature and extent of the disease (100% sensitivity and 78% spe cificity). A combined intracranial-extracranial approach (six cases) gave a distinct advantage over only adopting an extracranial approach(12 cases). A 17% incidence of CSF leak was noted by adopting only an extracranial appr oach as well as a recurrence in four cases out of the 12 that were treated using this method (P<0.05). A slight increase in morbidity was associated w ith the combined intracranial-extracranial treatment, but no recurrence or significant complications were noted in this approach.