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Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center.
Das, Anand Kumar; Mani, Suraj Kant; Singh, Saraj Kumar.
  • Das AK; Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India.
  • Mani SK; Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India.
  • Singh SK; Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India.
Surg Neurol Int ; 13: 335, 2022.
Article in English | MEDLINE | ID: covidwho-2006708
ABSTRACT

Background:

Mucormycosis, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. Immunocompromised patients are particularly prone to developing this disease. The most common form of presentation is rhino-orbito-cerebral mucormycosis (ROCM). We present various neurosurgical approaches to an entire spectrum of its clinical manifestations.

Methods:

This is a retrospective study of patients who were admitted to the neurosurgery department with ROCM and a history of COVID-19 infection between November 1, 2020, and September 1, 2021. All cases of ROCM underwent contrast-enhanced computed tomography/magnetic resonance imaging of the brain, paranasal sinuses, and orbit. A tissue biopsy was sent for histopathological analysis. All confirmed cases received liposomal amphotericin B and surgical treatment was immediately undertaken.

Results:

Out of 200 patients with ROCM, 40 patients presented with neurological manifestations. Seven out of 40 patients had focal lesions in the brain and skull bone that needed neurosurgical intervention along with sinus debridement and antifungal treatment. These seven patients presented with different clinical manifestations large-vessel stroke (one), medium-vessel stroke (one), frontal lobe abscess (one), frontal bone osteomyelitis (two), isolated central nervous system involvement (one), and mucor mimicking trigeminal schwannoma (one). The surgical intervention included decompressive craniectomy, frontal craniotomy, subtemporal craniotomy, and a minimally invasive supraorbital keyhole approach.

Conclusion:

In high-risk patients, a high level of clinical suspicion combined with appropriate investigations should be performed as soon as possible. Symptoms and early warning signs should not be overlooked, as treatment delays can be fatal. A minimally invasive surgical approach is possible in view of decreasing the morbidity of large craniotomy.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Topics: Long Covid Language: English Journal: Surg Neurol Int Year: 2022 Document Type: Article Affiliation country: SNI_374_2022

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Topics: Long Covid Language: English Journal: Surg Neurol Int Year: 2022 Document Type: Article Affiliation country: SNI_374_2022