Cavernous Sinus Involvement in Rhino-orbital Cerebral Mucormycosis and Impact of Concurrent COVID-19 on Patient Outcome: A Retrospective Observational Study.

Background: Cavernous sinus thrombosis (CST) in rhino-orbital cerebral mucormycosis (ROCM) poses a challenge for clinicians in predicting outcomes and formulating management strategies, particularly with the concurrent coronavirus disease 2019 (COVID-19) infection.

Purpose: This study was done to evaluate cavernous sinus (CS) involvement in ROCM. Additionally, we explored the association between CS thrombosis and COVID-19, exploring its potential impact on patient mortality.

Materials and methods: A retrospective analysis was conducted on 106 ROCM patients, examining their COVID-19 status and reviewing imaging findings from contrast-enhanced computed tomography (CT) and magnetic resonance (MR). The imaging assessment focused on evaluating fungal sinusitis, identifying CS involvement qualitatively, and detecting extension to orbit or other intracranial areas. Findings were correlated with patient mortality.

Results: CS involvement in ROCM was 48.1%, with a higher distribution (clinically insignificant) in COVID-positive patients (51.8%) compared to the COVID-negative group (34.8%). Most participants showed unilateral (78%) and diffuse pattern (71%) of CS involvement. A statistically significant association was observed between CS imaging parameters (filling defect, diffuse involvement pattern, convex shape of the lateral wall, and orbital cellulitis) and patient mortality, according to bivariate analysis (p < 0.05). Among 106 ROCM patients, 9.4% succumbed to the disease, with significantly higher mortality in those with CS thrombosis. However, subgroup analysis for the additional effect of COVID-19 on mortality yielded nonsignificant results.

Conclusion: CS involvement in ROCM does not significantly impact mortality in both COVID-positive and negative patients. Imaging parameters such as filling defects, diffuse CS involvement, convex lateral wall, and orbital cellulitis may suggest the disease severity when observed.