Results
Six patients were included. The median age of the patients was 58 years
old (range 25-69); 2/6 patients were female. Among all patients, only
one was immunocompromised due to heart transplantation. The right
frontal sinus was involved in 1/6 patients, one of them reported
bilateral infection. The most common symptom was headache; one patient
was referred to our center for persistence of FSA after two endoscopic
procedures performed in other centers.
All the patients underwent preoperative CT and/or MR imaging.
Non-invasive FSA characteristics, especially the relation with
surrounding bony structures were described (Tab 1). Six patients
underwent exclusive endoscopic sinus surgery with a complete removal of
the material, which was sent for pathologic and microbiologic evaluation
to confirm the presence of fungal hyphae and mycotic colonization in the
culture. A biopsy of the health mucosa of the frontal sinus was also
performed and excluded fungal invasion. In one case (patient n. 5) a
revision surgery was performed for a stenosis of the frontal sinusotomy
which occurred 11 months after the initial surgery (Tab 1). All of them
were followed with endoscopic control with a median of 71 months (range
13-240), no recurrences of FSA have been reported.
With regards to literature review, 17 papers have been identified
reporting a total number of 30 cases of FSA. We analyzed data on
geographic provenance of the patients, symptoms, radiological findings
focusing on the presence of bone damages, surgical treatment and
recurrences (Tab 2).