Strategies for the Diagnosis and Management of Chronic Invasive Fungal Sinusitis Involving the Skull Base or Orbit Based on the Background of Multidisciplinary Team Discussion

Abstract

To explore the diagnostic and therapeutic strategies of chronic invasive fungal sinusitis involving the skull base or orbit based on the background of multidisciplinary team discussion and to provide a basis for clinical practice. The clinical data of five patients with chronic invasive fungal sinusitis involving the skull base or orbit admitted to the Department of Otorhinolaryngology, Head and Neck Surgery of Drum Tower Hospital affiliated with Nanjing University School of Medicine from July 2017 to February 2024, were retrospectively analysed. The diagnosis and treatment strategies were all formulated after the MDT discussion. Nasal endoscopic surgery dominated the treatment protocol. Surgery was completed while ensuring the integrity of the dura mater or orbital periosteum. During surgery, we remove the lesion as thoroughly as possible and open the sinuses to improve their drainage function. The efficacy of the surgery was comprehensively analysed in the postoperative period. None of the five patients had serious complications such as ocular motor or visual dysfunction, cerebrospinal fluid leakage or intracranial infection after surgery. Four of them were cured after comprehensive treatment and had no recurrence after 5–84 months of follow-up; one case had a wider range of lesions, but the patient did not follow the recommended antifungal treatment after surgery and had a recurrence 5 months after surgery; after the recurrence, the patient underwent a second endoscopic surgery and actively cooperated with the antifungal treatment, there were no complications after the second surgery and there was no recurrence after 78 months of follow-up. For patients with chronic invasive fungal sinusitis involving the skull base or orbits, the diagnosis and treatment plan are formulated through MDT discussion before surgery, and the lesions are resected with the assistance of image navigation and the plasma system to protect the natural barrier of the dura mater or orbital periosteum from being breached, so as to achieve the purpose of removing the lesions and clearing the sinus drainage, and then supplemented with antifungal treatment. In this way, we can achieve satisfactory therapeutic effects while reducing nose–brain and nose–eye complications and improving the prognosis.