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B Schuknecht

Publications and source records attributed to B Schuknecht.

At least 19 recordsLinked to original sources
PubMed2006

The surgeon's view of the anterior ethmoid artery.

OBJECTIVES: To define the relationship of the anterior ethmoid artery to the frontal recess and secondly whether the degree of pneumatisation of the suprabullar recess/supraorbital cell correlates with the distance between the anterior ethmoid artery and the skull base thus making it more vulnerable to damage during surgery. METHOD: Thirty-four cadaver head sides were perfused with pink latex. All specimens had high-resolution computed tomography (CT) scans using bone windows in the axial, coronal and sagittal planes. The specimen's nasal septum was removed and the ethmoid sinuses dissected to locate the anterior ethmoid artery. Calipers were used to measure distance between the artery and the frontal recess and from the skull base. RESULTS: The anterior ethmoid artery was found in all the specimens and scans. The distance between the anterior ethmoid artery and the posterior wall of the frontal recess was 11 mm (range 6-15 mm). In all specimens, the artery was seen between the second and third lamella. The commonest location of the artery was in the suprabullar recess (85.3%). Supraorbital cells were seen in 16 specimens. The ethmoid sinuses were well pneumatised with a large supraorbital cell in 10 of these specimens and in these the artery was lying 3.7 mm (range 1-8 mm) away from the skull base. Six specimens had poor pneumatisation and a small supraorbital cell and in these the artery was found close to or with in the skull base. In specimens without a supraorbital cell, the artery lay at the skull base in all but one. CONCLUSIONS: The position of the anterior ethmoidal artery is very variable. The artery is found between the second and third lamella. When the ethmoid sinuses are more pneumatised and in particular when there is a supraorbital cell, the artery lies below the skull base. A good strategy is to identify the degree of pneumatisation of the ethmoid sinuses from CT scans preoperatively to see if the artery is at an increased risk of being damaged.

Arteries↗
PubMed2005

Distal posterior inferior cerebellar artery aneurysms: clinical characteristics and surgical management.

BACKGROUND: Aneurysms located on the distal posterior inferior cerebellar artery (PICA) are rare, and their underlying clinical features and surgical management are poorly understood. We report our series of 16 patients with 18 distal PICA aneurysms. METHOD: All patients with distal PICA aneurysms were treated between March 1996 and August 2004. We excluded all PICA aneurysms that involved the vertebral artery. Patients were analysed in the light of their clinical profiles, radiological studies, intraoperative findings and outcomes. All patients underwent non-enhanced and contrast enhanced CT scans followed by 4-vessel cerebral angiography on admission. The hemorrhagic patterns on initial CT scans were assessed using the Fisher Grading Score. The outcomes were documented using the Glasgow Outcome Scale at time of discharge and at three or twelve months follow-up. FINDINGS: The series included 6 men and 10 women. Massive intraventricular haemorrhage was found in 13 patients with proven CT subarachnoid haemorrhage, one patient revealed SAH without intraventricular components, one presented with only intraventricular blood in the occipital horns and 3 aneurysms were found incidentally without presence of blood. Fourteen aneurysms were saccular and four were fusiform. Nine cases were associated with another cerebrovascular lesion. A lateral transcondylar or a median suboccipital approach was used to secure the aneurysms in 15 patients, either by direct clipping (14 lesions) or vessel sacrifice (3 lesions). One aneurysm was treated by an endovascular approach. At long-term follow up, an excellent or good outcome was achieved in 75% of cases. One patient died due to pre-existing cardiopulmonary complications. CONCLUSIONS: Most of our cases of ruptured distal PICA aneurysms presented with haematocephalus. These were frequently associated with another vascular abnormality and 22% were fusiform or multilobulated. These specific features require special management strategies entailing an appropriate surgical approach to the aneurysm, clipping method, haematoma removal, ventricular drainage and when suitable choice of endovascular interventions.

Adult↗
PubMed2005

Endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

Endovascular treatment by balloon angioplasty or intra-arterial papaverine infusion has been established as a valuable treatment option in patients with cerebral vasospasm refractory to maximal medical therapy. A summary of the indications, applications and limitations is provided for microcatheter guided selective papaverine infusion and transluminal balloon angioplasty in patients who sustain cerebral vasospasm following subarachnoid haemorrhage. Structured neuro-intensive and endovascular treatment of imminent vasospasm integrate papaverine administration and balloon angioplasty as complimentary rather than alternative techniques.

Embolization, Therapeutic↗
PubMed2005

Clinical significance of detection of multiple acute brain infarcts on diffusion weighted magnetic resonance imaging.

BACKGROUND: Detection of multiple acute brain infarcts (MABI) by diffusion weighted magnetic resonance imaging (DWI) may provide information about stroke mechanism in (1) acute lacunar stroke, where evidence of MABI suggests a cause other than small artery disease (SAD), such as embolism or vasculitis (type 1 MABI); or (2) acute non-lacunar stroke, where MABI in the territory of at least two of the aortic branches supplying the brain indicates the presence of aortic or cardiac embolism rather than artery to artery embolism (type 2 MABI). OBJECTIVE: To evaluate the prevalence of MABI and their impact on aetiological classification and prevention of stroke in patients with acute ischaemic stroke examined with DWI. METHODS: 182 consecutive patients defined by DWI were evaluated. Stroke aetiology was classified according to the TOAST criteria, though "lacunar stroke" included patients with possible aetiologies other than SAD. RESULTS: Type 1 MABI were detected in 21/72 patients (29%) with lacunar stroke, and type 2 MABI in 8/110 (7%) with non-lacunar stroke. A possible stroke mechanism different from SAD was found in nine type 1 MABI cases (43%): cardiac embolism (4); other determined aetiology (3); aortic embolism (2). Cardiac (2) or aortic (1) sources of embolism were detected in eight type 2 MABI cases. MABI patients with cardiac or aortic sources of embolism were treated with warfarin, the remainder with aspirin. CONCLUSIONS: Detection of type 1 MABI in patients with lacunar stroke improved diagnostic confidence and the choice of antithrombotic treatment. Further study is needed on stroke prevention in MABI cases caused by SAD alone.

Brain↗
PubMed2004

Solitary fibrous tumor of the orbit--two cases and a review of the literature.

Solitary fibrous tumors of the orbit (SFT) are mesenchymal lesions that can develop either as malignant or benign neoplasias. We describe the histological features leading to the diagnosis in two females and review the current literature. Diagnosis of SFT only can be performed by histological examination, since clinical signs and radiological features are not specific enough. Even a malignant or benign course cannot be predicted, since clinical and radiological features do not correlate with histological signs of malignancy and vice versa. Radical resection is the treatment of choice, since no other treatment option has been proven to be efficient.

Aged↗
PubMed2004

[An endocranial complication of sinogenic origin without initial classical neurological symptoms].

A 14 year old male developed a subdural empyema with a leptomeningeal infection of sinogenic origin. Initially, there were none of the expected neurological symptoms such as worsening headaches, vomiting, alteration in the level of consciousness and neck stiffness. Later, focal neurological deficits and seizures occurred. An endonasal sinus drainage was performed simultaneously with a neurosurgical exploration. We started an antibiotic therapy. All neurological deficits disappeared rapidly.

Adolescent↗
PubMed2004

Latest techniques in head and neck CT angiography.

Continuous evolution of multi row CT is increasingly making CT angiography a viable imaging modality for assessment of the supraaortic and intracranial vessels as an anatomically and functionally coherent vascular system. Extended non-invasive examinations with reduced contrast volume have become feasible with the availability of 16 and 64 row MDCT scanners. Prerequisites to obtain high resolution CT angiographies of the head and neck vessels with superior detail include the administration of low contrast volume, high contrast density (400 mg I/ml) contrast media, adequate timing and data acquisition, optimal flow rate (4 ml/s) and saline flushing. Non-invasiveness, delineation of vessel calcification, virtual independence from hemodynamic conditions, and the ability to provide quantification without needing to correct for magnification are all attributes that favour CT angiography over digital subtraction angiography and to some extent even magnetic resonance angiography as an alternative non-invasive technique. CT angiography is established as a modality of choice for the assessment of patients with acute stroke and chronic steno-occlusive disease. CT angiography may indicate the presence of extra- or intracranial acute vessel occlusion and dissection, predisposing atherosclerotic steno-occlusive disease and thus indicate thrombo-embolism or local appositional thrombosis as the principle pathogenic factor. CT angiography is used to assess anatomy, and to depict the presence, location and extent of calcified and non-calcified plaque as a cause of high grade stenosis. Despite relatively limited sensitivity CT angiography is indicated for suspected or confirmed aneurysms that demand further verification of their presence, geometry, or relationship to parent artery branches and osseous anatomic landmarks. Low volume high density contrast media have substantially increased the ability of CT angiography to depict small aneurysms, small branches, and collateral vessels, and to recognize the residual lumen in vessels with high grade stenosis or conditions such as dissection or pseudo-occlusion. Superior detail high resolution CT angiography is thus a viable alternative to DSA, relegating the latter technique to endovascular treatment applications only.

Angiography↗
PubMed2004

Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis.

OBJECTIVE: To define predictors of recanalisation and clinical outcome of patients with acute basilar artery occlusions treated with local intra-arterial thrombolysis (IAT). METHODS: Vascular risk factors, severity of the neurological deficit graded by the National Institutes of Health stroke scale (NIHSS), and radiological findings were recorded at presentation. Outcome was measured using the modified Rankin scale (mRS) three months later and categorised as favourable (mRS 0-2), poor (mRS 3-5), or death (mRS 6). RESULTS: 40 patients were studied. Median NIHSS on admission was 18. Mean time from symptom onset to treatment was 5.5 hours (range 2.3 to 11). Outcome was favourable in 14 patients (35%) and poor in nine (23%); 17 (42%) died. There were two symptomatic cerebral haemorrhages (5%). Recanalisation of the basilar artery was achieved in 32 patients (80%); it was complete (TIMI grade 3) in 20% and partial (TIMI grade 2) in 60%. In multivariate logistic regression analysis, low NIHSS score on admission (p = 0.002) and vessel recanalisation (p = 0.005) were independent predictors of favourable outcome. Recanalisation occurred more often with treatment within six hours of symptom onset (p = 0.003) and when admission computed tomography showed a hyperdense basilar artery sign (p = 0.007). In a univariate model, quadriplegia (p = 0.002) and coma (p = 0.004) were associated with a poor outcome or death. CONCLUSIONS: Low baseline NIHSS on admission and recanalisation of basilar artery occlusions predict a favourable outcome after intra-arterial thrombolysis. Early initiation of IAT and the presence of a hyperdense basilar artery sign on CT were associated with a higher likelihood of recanalisation.

Acute Disease↗
PubMed2003

Moyamoya disease and Moyamoya syndrome: experience in Europe; choice of revascularisation procedures.

OBJECTIVES: To present our clinical experience in terms of disease presentation and choice of revascularisation procedure in our first group of 23 European Moyamoya angiopathy (disease and syndrome) patients. METHOD AND PATIENT SELECTION: Twenty three patients were diagnosed and treated from 1997-2001 in our neurosurgical department. All patients underwent preoperative angiography, colour Doppler examination, cranial MRI and/or CT scans, HMPAO-SPECT or H(2)(15)O PET (baseline and Diamox challenge) scans. Nineteen patients presented with child-juvenile Moyamoya angiopathy with an average age at presentation of 8 years (range 1-17 years), in 4 patients adult Moyamoya was diagnosed with a mean age at presentation of 34 years (range 23-40 years). RESULTS: In all but one patient bilateral affection was present at the time of diagnosis. All patients underwent direct and/or additional indirect revascularisation procedures. Twenty-one patients underwent bilateral revascularisation procedures. In two patients a unilateral procedure was performed. A direct STA-MCA bypass (superficial temporal artery branch - middle cerebral artery branch anastomosis) was performed in all patients. Additional direct STA-ACA bypass (STA - anterior cerebral artery branch anastomosis) was performed in 10 patients. Indirect arteriosynangiosis using the occipital artery was performed in the posterior cerebral artery (PCA) territory in 3 patients. The frontal branch of the STA was used for arteriosynangiosis in the frontal region in another 2 patients. Indirect frontal durasynangiosis was performed in 14 patients. The number and location of multiple revascularisation procedures was determined according to the angiographic findings as well as the site of decreased perfusion reserves seen on H(2)(15)O PET. A one stage revascularisation procedure was performed in 7 patients. Fourteen patients underwent two stage procedures. Following operation no complications were encountered in all but one adult patient who died postoperatively due to a massive middle cerebral artery infarct on the nonoperated side. CONCLUSIONS: As territorial hemodynamic disorder seems to be a characteristic in Moyamoya disease and/or syndrome, judging from our experience with European patients in our series, and several reports hitherto, treatment with multiple revascularisation procedures is considered to be justified.

Adolescent↗
PubMed2002

Presentation and management of patients with initial negative 4-vessel cerebral angiography in subarachnoid hemorrhage.

The importance of repeat-angiography in patients with acute subarachnoid hemorrhage (SAH) and initial negative angiography has been reviewed in the light of our patient population (19 patients with initial negative angiography/168 patients with SAH). The type of SAH i.e., nontraumatic perimesencephalic SAH versus focal or generalized non perimesencephalic SAH, as well as the amount and distribution of blood on the initial CT examination are important factors in decision making. 3D-Angio-CT, in 3/5 patients, and MR-angiography (MRA) in 1/5 patients were complementary non-invasive methods to diagnose aneurysms on repeated examinations. Repeat-cerebral angiography confirmed the source of hemorrhage in 3 patients.

Adult↗
PubMed2002

Evaluation of topography and vascularization of cervical paragangliomas by magnetic resonance imaging and color duplex sonography.

The management of cervical paragangliomas (PGs) depends on their specific type and their relation to adjacent vessels. The purpose of this study was to evaluate the potential of magnetic resonance imaging (MRI) and color duplex sonography (CDS) to classify PGs according to topography and vascularization. Sixteen patients harboring 22 PGs were studied retrospectively. With digital subtraction angiography as reference, the topographic relation of the tumors to the carotid arteries and the internal jugular vein and the patterns of vascularization were assessed. On MRI and CDS the typical feature of 15 carotid PGs was splaying of the carotid bifurcation, with the external carotid displaced anteriorly and the internal carotid artery and internal jugular vein located posteriorly. In five vagal PGs both modalities showed unidirectional anterior displacement of the external and internal carotid arteries. Two jugular PGs were found to extend within the lumen of the internal jugular vein. CDS completely depicted carotid body tumors but failed to delineate the high cervical portion of vagal and jugular PGs. MRI allowed us to assess the entire extent of all PGs. Nineteen lesions showed flow voids corresponding to abundant flow signal on CDS: three carotid body tumors appeared hypovascular on CDS and MRI. On CDS, intratumoral flow was directed cranially in carotid and inferiorly in vagal and jugular PGs. CDS and MRI are suitable for classification of cervical PGs as carotid, vagal or jugular PGs based on the topographic relation to the carotid arteries and internal jugular vein. Visualization of the intrinsic tumor vasculature proved an additional distinguishing criterion on CDS.

Adult↗
PubMed2002

[State of the Art. Diagnostic imaging of paranasal sinus diseases].

The following article describes a diagnostic concept of paranasal sinus imaging, based on more than 10 years close collaboration of the authors. CT and MR are the primary imaging modalities for investigating paranasal sinus lesions. Conventional X-ray images add little information due to insufficient sensitivity. Angiography is restricted to those patients who require preoperative tumor embolization or emergency treatment of intractable epistaxis. After thorough medical treatment of inflammatory paranasal sinus disease, CT becomes the method of choice to clearly depict preoperative osseous anatomy and to distinguish between benign and malignant intraosseous lesions. In cases where trauma is involved, CT easily identifies anterior skull base fractures. Moreover, CT will be the first step to localize early or late CSF rhinorrhea. MR, with its ability to distinguish between different soft tissues, compliments CT. This holds particularly true for inflammatory or neoplastic disease close to the skull base, orbital apex and cavernous sinus. The signal intensity in T(1) and T(2) weighted images provides additional information with respect to cellularity and vascularization of lesions, which has important diagnostic and therapeutic implications.

Angiography, Digital Subtraction↗
PubMed2001

Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings.

OBJECTIVE: To study whether spontaneous dissections of the cervical internal carotid artery dissection (ICAD) with and without ischemia of the brain or retina differ in the prevalence of vascular risk factors, local neurologic signs and symptoms, and stenoses and occlusions of the cerebral arteries. METHODS: The authors prospectively studied 181 consecutive patients with 200 ICAD. Diagnosis was based on ultrasonography and MRI or catheter angiography. Vascular risk factors, presenting local (headache, neck pain, Horner syndrome, pulsatile tinnitus, cranial nerve palsy on the side of the ICAD) and ischemic signs and symptoms, and ultrasonographic findings in the carotid and basal cerebral arteries were evaluated. RESULTS: ICAD with ischemic events (n = 145) had a higher prevalence of hypercholesterolemia (p < 0.05), >80% stenoses and occlusions of the ICA (p < 0.0001), and intracranial obstructions (p < 0.001). ICAD without ischemic events (n = 55) had a higher prevalence of Horner syndrome (p < 0.001), cranial nerve palsy (p < 0.01), and normal ICA findings (p < 0.0001). CONCLUSIONS: These data suggest that ICAD causing high-grade stenosis and occlusion are more likely to lead to intracranial obstructions and cerebral or retinal ischemic events. Conversely, ICAD without luminal narrowing cause more local signs and symptoms.

Adolescent↗
PubMed1999

Endovascular treatment of cerebral vasospasm: assessment of treatment effect by cerebral angiography and transcranial colour Doppler sonography.

In a retrospective study of 30 consecutive patients with symptomatic vasospasm the mean degree of narrowing as compared to the initial angiogram was 35% (+/- 24%) in 12 intradural internal carotid arteries (ICA), 42% (+/- 17%) in 42 proximal middle cerebral (MCA) and 38% (+/- 19%) in 27 anterior cerebral arteries (ACA). The corresponding increase in mean flow velocities from baseline values obtained by transcranial colour Doppler sonography (TCD) within 12 h of the first angiogram to the time of clinical vasospasm was considerably higher, with 49% (+/- 34%) in the ICA 119% (+/- 92%) in the MCA and 147% (+/- 170%) in the ACA. Following superselective intra-arterial papaverine application in 66 arteries and balloon angioplasty of 15 arteries, 78 (96.3%) of 81 dilated. Sustained clinical improvement was achieved in 22 patients (73.3%). The mean reversal of angiographic vasospasm was 71% for the ICA (range 10-100%), 81% for the MCA (range 9-100%) and 82% (range 0-100%) for the A1 segment. The mean reduction of flow velocities after treatment was much less with 23% (+/- 21%) in the ICA, 32% (+/- 24%) in the MCA and 25% (+/- 22%) in the A1 segment.

Adult↗
PubMed1999

Colour-coded Doppler sonographic study of the haemodynamics in the parent artery of intracranial aneurysms.

We investigated the haemodynamics in the parent artery of 17 small (< 9 mm) and 17 large (L 9.5 mm) saccular aneurysms by transcranial colour-coded Doppler sonography (TCCD) and related the findings to digital subtraction angiography (DSA). We measured flow velocity within the parent artery and, by positioning the Doppler gate within the colour flow image close to the ostium of the aneurysm, obtained a superselective Doppler spectral waveform. The parameters measured included the time-averaged maximal velocity (TAMX), peak systolic, and end-diastolic velocity and pulsatility index (PI). The values were compared to the contralateral side and between small and large aneurysms. DSA was analysed for parent artery stenosis. Mean systolic velocities in the parent arteries of large aneurysms were significantly higher than in the contralateral normal artery (1.08 +/- 0.23 vs 0.80 +/- 0.23 m/s; P = 0.0003) and higher than in the parent artery of small aneurysms (0.89 +/- 0.18 m/s; P = 0.01). Increased systolic velocity accounted for a higher PI in the parent artery of large aneurysms (mean 1.48 +/- 0.42) than on the other side (0.87 +/- 0.12; P = 0.0001) and in the parent artery of small aneurysms (0.85 +/- 0.14; P = 0.0001). PI proximal to seven thrombosed large aneurysms was higher (mean 1.85 +/- 0.38) than close to unthrombosed large aneurysms (1.23 +/- 0.22; P = 0.0005). Increased PI and systolic velocities could not be shown within branches of 5 large aneurysms and were reversible in the parent artery of four patients examined again after occlusion of the aneurysm. Systolic velocities and PI did not differ significantly (P = 0.41 and P = 0.25, respectively) in ruptured and unruptured aneurysms. Stenosis of the parent artery was not shown by DSA in any case.

Adult↗
PubMed1999

Clinical, angiographic, and sonographic findings after structured treatment of cerebral vasospasm and their relation to final outcomes.

OBJECTIVE: To report the early clinical results, quantitative angiographic and sonographic findings, and final outcome in patients with symptomatic vasospasm who had undergone surgical occlusion of the aneurysm and a structured protocol including aggressive intensive care management, endovascular procedures (EP), and barbiturate coma (BC). RESULTS: Thirty consecutive patients (19 women, 11 men, age: 51 +/- 8 years) underwent 38 EP for the treatment of 81 vascular territories (15 balloon dilatations and 66 papaverine infusions). Overall angiographic vasospasm in the intradural ICA improved significantly from 44.7 +/- 19.8% to 16.5 +/- 16%, in the MCA from 44.2 +/- 14.7% to 14.4 +/- 14%, and in the ACA from 38.7 +/- 18.6% to 13.3 +/- 12%. Mean flow velocities (Vm) in the MCA and ACA decreased significantly from 135 +/- 48 cm/sec to 87 +/- 32 cm/sec and from 110 +/- 36 cm/sec to 84 +/- 30 cm/sec, respectively. No significant Vm improvement in the ICA could be demonstrated. Six patients (20%) developed intractable vasospasm after repeated EP and five patients underwent BC. The correlation coefficient between percentage of angiographic vasospasm and Vm increase was -0.19 (p = NS) for the ICA, 0.2 (p < 0.001) for the MCA, and 0.3 (p < 0.05) for the ACA. Correlation coefficient between percentages of angiographic and sonographic improvement was -0.12 (p = NS) for the ICA, 0.42 (p < 0.001), and 0.1 (p < 0.05) for the ACA. Early clinical improvement after EP was observed in 73% of patients and was significantly associated with favourable outcome (GOS 4-5). Sixteen patients (53%) had a GOS 5, six patients (20%) a GOS 4, six patients (20%) a GOS 3, and two patients (6.6%) died as consequence of devastating vasospasm. CONCLUSIONS: Changes in vessel diameter and increases of Vm during vasospasm correlate weakly. In spite of the fact that significant differences in vessel diameter and Vm were demonstrated after treatment, a moderately good correlation between percentages of angiographic and Vm improvement was observed only in the M1 segments. In our experience, a reduction of mortality and disabilities can be achieved with a maximal structured treatment of vasospasm. Early clinical improvement after endovascular treatment is strongly associated with favourable outcome, nevertheless, cost-benefit and controlled trials are necessary to evaluate these techniques.

Adult↗
PubMed1998

[Chronic mycoses of the paranasal sinuses--value of endonasal paranasal sinus surgery].

BACKGROUND: Many host factors even in immunocompetent patients may have an influence on development of a fungal diseases within the paranasal sinuses. Fungal sinusitis can occur in an acute form or more often to a chronic type of the disease. These mainly relatively asymptomatic chronic forms and further divided into a chronic noninvasive, chronic allergic, and chronic invasive disease. Endonasal microsurgery has significantly changed the management of chronic fungal sinusitis and allows adequate removal of pathologic tissue even in advanced situations. The aim of this study was to analyze the efficacy of endonasal surgery in chronic fungal sinusitis. MATERIAL AND METHODS: In a retrospective study we assessed a group of 40 patients who had endonasal surgery for chronic fungal sinusitis. Patient records, CT and MRI scans, microbiology and histology as well as the postoperative clinical follow-up including endoscopic photo documentation were evaluated over a period of 5 years. All patients underwent endonasal surgery using endoscopic techniques. The microscopic was of additional help in a few cases with extended disease and multiple dehiscences of the skull base. RESULTS: Twenty-four patients had a chronic noninvasive of fungal sinusitis and 16 patients had a chronic invasive form. All these patients underwent endonasal surgery without external incision. The fungal disease was erradicated in 39 cases, and revision surgery was required in only one case in which involvement of the contralateral side was not initially detected. in two cases scar tissue in the middle meatus was later excised but without evidence of residual fungal disease. Only in 6 cases was antifungal chemotherapy required, where the disease had spread into surrounding tissue or the patient had severe symptoms. CONCLUSIONS: Endonasal microsurgical techniques are today the appropriate approach for managing chronic fungal sinus disease even in severe cases with radiologic evidence of expansion or invasion of surrounding tissue. Additional antifungal chemotherapy is only rarely indicated, specifically when the fungal disease invades surrounding tissue.

Adult↗