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).