{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T23:24:30Z","timestamp":1787268270979,"version":"build-2736575974"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Intracranial (IC) extension is a poor prognostic factor for acute invasive fungal sinusitis (IFS). There are no studies on the role of IC debridement in the setting of rhinocerebral IFS.<\/jats:p>\n                  <jats:p>We retrospectively reviewed patients with rhinocerebral IFS confirmed on imaging who underwent surgical management. Patients who underwent sinonasal debridement only (reference group) were compared with those who underwent sinonasal and IC debridement (IC group). The primary outcome was overall survival. Univariate analysis and logistic regression were performed to assess for differences in clinical characteristics between the treatment groups and predictive factors of survival.<\/jats:p>\n                  <jats:p>Twenty-nine patients were included in the study, with 10 patients in the IC group and 19 patients in the reference group. There were no significant differences in patient demographics or predisposing conditions between the groups. Regarding IC extent of fungal disease, there were no significant differences in rates of dural, leptomeningeal, or parenchymal involvement; cavernous sinus extension; or cisternal cranial nerve involvement. The IC group had significantly more IC abscesses (60%) than the reference group (5%, p\u2009=\u20090.002). At the time of the most recent follow-up (month, year), 30% (n\u2009=\u20093) of the IC group, and 79% (n\u2009=\u200915) of the reference group had died (p\u2009=\u20090.02). The Cox proportional hazards model demonstrated a 93% reduction in the risk of death with IC debridement when adjusting for all covariables (p\u2009=\u20090.004).<\/jats:p>\n                  <jats:p>This study is the largest series to examine neurosurgical management of rhinocerebral IFS, demonstrating possible survival benefit with IC debridement in select patients and with highly specialized surgical expertise.<\/jats:p>","DOI":"10.1055\/a-2706-1268","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T22:45:06Z","timestamp":1760049906000},"page":"514-522","source":"Crossref","is-referenced-by-count":0,"title":["Does Debridement of Intracranial Disease in Acute Invasive Fungal Sinusitis Improve Survival?"],"prefix":"10.1055","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8326-4997","authenticated-orcid":false,"given":"Alice E.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2072-982X","authenticated-orcid":false,"given":"Zara M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"},{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9519-5880","authenticated-orcid":false,"given":"Michael T.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1002\/lary.23912","article-title":"Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence","volume":"123","author":"J H Turner","year":"2013","journal-title":"Laryngoscope"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jaci.2011.11.039","article-title":"Fungal disease of the nose and paranasal sinuses","volume":"129","author":"G R Thompson III","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1186\/1471-2334-11-250","article-title":"Invasive fungal sinusitis in patients with hematological malignancy: 15 years experience in a single university hospital in Taiwan","volume":"11","author":"C Y Chen","year":"2011","journal-title":"BMC Infect Dis"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1086\/590004","article-title":"Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis","volume":"47","author":"G Chamilos","year":"2008","journal-title":"Clin Infect Dis"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"3688","DOI":"10.1038\/s41598-020-60719-7","article-title":"Treatment outcomes in acute invasive fungal rhinosinusitis extending to the extrasinonasal area","volume":"10","author":"S H Nam","year":"2020","journal-title":"Sci Rep"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2500\/ajra.2017.31.4420","article-title":"Complete surgical resection and short-term survival in acute invasive fungal rhinosinusitis","volume":"31","author":"C R Roxbury","year":"2017","journal-title":"Am J Rhinol Allergy"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1111\/coa.13175","article-title":"A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years?","volume":"43","author":"C Vaughan","year":"2018","journal-title":"Clin Otolaryngol"},{"issue":"S 03","key":"ref8","doi-asserted-by":"crossref","first-page":"e330","DOI":"10.1055\/s-0040-1701681","article-title":"Benefit of endoscopic surgery in the management of acute invasive skull base fungal rhinosinusitis","volume":"82","author":"M R D'Andrea","year":"2021","journal-title":"J Neurol Surg B Skull Base"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1177\/0194599815627786","article-title":"Acute invasive fungal rhinosinusitis: a 15-year experience with 41 patients","volume":"154","author":"S J Payne","year":"2016","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.otohns.2010.08.017","article-title":"Acute invasive fungal rhinosinusitis: evaluation of 26 patients treated with endonasal or open surgical procedures","volume":"143","author":"F Kasapoglu","year":"2010","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"12","key":"ref11","doi-asserted-by":"crossref","first-page":"4281","DOI":"10.1007\/s00405-016-4109-z","article-title":"Acute invasive fungal rhinosinusitis: our experience with 18 cases","volume":"273","author":"M Bakhshaee","year":"2016","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"07","key":"ref12","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1002\/lary.23978","article-title":"Invasive fungal rhinosinusitis: a 15-year experience with 29 patients","volume":"123","author":"M M Monroe","year":"2013","journal-title":"Laryngoscope"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jcms.2012.03.019","article-title":"The surgical management of rhinocerebral mucormycosis","volume":"41","author":"I Abu El-Naaj","year":"2013","journal-title":"J Craniomaxillofac Surg"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"143","DOI":"10.4103\/0974-777X.170497","article-title":"Retrospective clinical study of eighty-one cases of intracranial mucormycosis","volume":"7","author":"J Ma","year":"2015","journal-title":"J Glob Infect Dis"},{"issue":"08","key":"ref15","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1002\/(SICI)1097-0347(199912)21:8<734::AID-HED9>3.0.CO;2-X","article-title":"Management of the cavernous sinus in en bloc resections of malignant skull base tumors","volume":"21","author":"K Saito","year":"1999","journal-title":"Head Neck"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1016\/j.wneu.2013.08.026","article-title":"Complete resection of the cavernous sinus-indications and technique","volume":"82","author":"W T Couldwell","year":"2014","journal-title":"World Neurosurg"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"e0007423","DOI":"10.1128\/cmr.00074-23","article-title":"Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease","volume":"37","author":"M Hoenigl","year":"2024","journal-title":"Clin Microbiol Rev"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1080\/14737159.2023.2267977","article-title":"An update on current and novel molecular diagnostics for the diagnosis of invasive fungal infections","volume":"23","author":"J D Jenks","year":"2023","journal-title":"Expert Rev Mol Diagn"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2706-1268.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T22:46:03Z","timestamp":1787265963000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2706-1268"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":18,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,8,20]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2706-1268","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"value":"2193-6331","type":"print"},{"value":"2193-634X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}