Samrendra Kumar Singh¹, Brajesh Kumar²* Niraj Kanaujia² Om Prakash Gupta², KM Jha³ and Rakesh Kumar Singh⁴

¹Associate Professor, Department of Neurosurgery, IGIMS, Patna, India
²Assistant Professor, Department of Neurosurgery, IGIMS, Patna, India
³Professor and Head of Department, Department of Neurosurgery, IGIMS, Patna, India
⁴Professor and Head of Department, Department of Otorhinolaryngology, IGIMS, Patna, India

*Corresponding Author: Brajesh Kumar, Assistant Professor, Department of Neurosurgery, IGIMS, Sheikhupura, Raza bazar, Patna, Bihar, India. E-mail: drbrajesh78@gmail.com

Received: September 22, 2021; Published: November 19, 2021

Abstract

Objective: Mucor-mycosis is a fungal infection which usually develops in severe immunocompromised patients, e.g., post-transplant, uncontrolled Diabetes Mellitus, malignancies, and iatrogenic immunosuppression. We faced flood of post-Covid Rhino cerebral Mucor mycosis cases at our institution after second wave of Covid from April to July 2021. We present our experience of ten patients who underwent neurosurgical intervention.

Patients and Methods: This was a prospective study of ten patients who underwent neurosurgical intervention for Rhino cerebral Mucor mycosis. All cases were operated by same surgeons from ENT and Neurosurgery. Disseminated brain abscess, multilobe involvement, brainstem involvement and isolated cavernous sinus thrombosis excluded from this study.

Results: Total forty-five patients referred for neurosurgical opinion, out of those ten patients taken for neurosurgical intervention. Out of ten, nine patients had history of Covid infection (RT-PCR positive). They were treated with steroid and oxygen inhalation. One patient had history of fever, but his Covid RT-PCR was negative. He was treated at home with oxygen. All patients were treated with either liposomal amphotericin B or conventional Amphotericin B depending on the availability and affordability of the patient. Oral Posaconazole (100 mg), six to eight hourly was given to all patients for 6weeks to 3 months in gradual tapering doses depending on the nasal endoscopic findings in the follow up. Sinus surgery was performed in all ten patients by ENT Surgeons, two underwent orbital exenteration by eye surgeon, eight patients underwent open craniotomy for cerebral infection while in two patients’ cerebral exploration done endoscopically. Eight patients survived, while two patients died.

Conclusion: Patients with rhino-cerebral mucormycotic spreading outside the Sino nasal cavity to the base of brain is treatable by early neurosurgical interventions when the abscess cavity is localized to frontal or temporal skull base.

Keywords: Rhino Cerebral; Mucor-mycosis; Post Covid; Immune Suppression

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Citation

Citation: Niraj Kanaujia., et al. “Post-covid Rhino Cerebral Mucor Mycosis: Neurosurgical Experience".Acta Scientific Otolaryngology 3.12 (2021): 17-23.

Copyright

Copyright: © 2021 Niraj Kanaujia. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.