{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:13:14Z","timestamp":1792181594520,"version":"4.4.0"},"reference-count":26,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Mucormycosis, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. Immunocompromised patients are particularly prone to developing this disease. The most common form of presentation is rhino-orbito-cerebral mucormycosis (ROCM). We present various neurosurgical approaches to an entire spectrum of its clinical manifestations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a retrospective study of patients who were admitted to the neurosurgery department with ROCM and a history of COVID-19 infection between November 1, 2020, and September 1, 2021. All cases of ROCM underwent contrast-enhanced computed tomography\/magnetic resonance imaging of the brain, paranasal sinuses, and orbit. A tissue biopsy was sent for histopathological analysis. All confirmed cases received liposomal amphotericin B and surgical treatment was immediately undertaken.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Out of 200 patients with ROCM, 40 patients presented with neurological manifestations. Seven out of 40 patients had focal lesions in the brain and skull bone that needed neurosurgical intervention along with sinus debridement and antifungal treatment. These seven patients presented with different clinical manifestations: large-vessel stroke (one), medium-vessel stroke (one), frontal lobe abscess (one), frontal bone osteomyelitis (two), isolated central nervous system involvement (one), and mucor mimicking trigeminal schwannoma (one). The surgical intervention included decompressive craniectomy, frontal craniotomy, subtemporal craniotomy, and a minimally invasive supraorbital keyhole approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In high-risk patients, a high level of clinical suspicion combined with appropriate investigations should be performed as soon as possible. Symptoms and early warning signs should not be overlooked, as treatment delays can be fatal. A minimally invasive surgical approach is possible in view of decreasing the morbidity of large craniotomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/sni_374_2022","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T07:11:45Z","timestamp":1659683505000},"page":"335","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center"],"prefix":"10.25259","volume":"13","author":[{"given":"Anand Kumar","family":"Das","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraj Kant","family":"Mani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saraj Kumar","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"10.25259\/SNI_374_2022\/ref-1","first-page":"1","article-title":"Association of COVID-19 with rhino-cerebral mucormycosis: An observational study","volume":"11","author":"Agarwal","year":"2021","journal-title":"J Maxillofac Oral Surg"},{"key":"10.25259\/SNI_374_2022\/ref-2","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s15010-021-01670-1","article-title":"COVID-19 and mucormycosis superinfection: The perfect storm","volume":"49","author":"Al-Tawfiq","year":"2021","journal-title":"Infection"},{"key":"10.25259\/SNI_374_2022\/ref-3","first-page":"e11776","article-title":"Rhinocerebral mucormycosis: A ten-year single centre case series","volume":"12","author":"Balai","year":"2020","journal-title":"Cureus"},{"key":"10.25259\/SNI_374_2022\/ref-4","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/MAJ.0b013e3181f0aad1","article-title":"Rhinocerebral mucormycosis complicated by bacterial brain abscess","volume":"340","author":"Cano","year":"2010","journal-title":"Am J Med Sci"},{"key":"10.25259\/SNI_374_2022\/ref-5","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/IOP.0000000000002030","article-title":"Clinical presentations, management and outcomes of rhino-orbital-cerebral mucormycosis (ROCM) Following COVID-19: A multi-centric study","volume":"37","author":"Dave","year":"2021","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"10.25259\/SNI_374_2022\/ref-6","doi-asserted-by":"crossref","first-page":"102148","DOI":"10.1016\/j.tmaid.2021.102148","article-title":"COVID-19-associated mucormycosis: Case report and systematic review","volume":"44","author":"Dilek","year":"2021","journal-title":"Travel Med Infect Dis"},{"key":"10.25259\/SNI_374_2022\/ref-7","doi-asserted-by":"crossref","first-page":"245","DOI":"10.25259\/SNI_275_2021","article-title":"Imaging features of perineural and perivascular spread in rapidly progressive rhino-orbital-cerebral mucormycosis: A case report and brief review of the literature","volume":"12","author":"Galletta","year":"2021","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_374_2022\/ref-8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12070-021-02753-z","article-title":"Rapid response preparedness for management of post-covid invasive rhino-orbito-cerebral fungal infections: experience from a tertiary care government institute in India","author":"Goyal","year":"2021","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"10.25259\/SNI_374_2022\/ref-9","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1007\/s00405-005-0919-0","article-title":"Rhinocerebral mucormycosis: Pathways of spread","volume":"262","author":"Hosseini","year":"2005","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"10.25259\/SNI_374_2022\/ref-10","doi-asserted-by":"crossref","first-page":"298","DOI":"10.3390\/jof7040298","article-title":"When uncontrolled diabetes mellitus and severe COVID-19 converge: The perfect storm for mucormycosis","volume":"7","author":"John","year":"2021","journal-title":"J Fungi (Basel)"},{"key":"10.25259\/SNI_374_2022\/ref-11","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1007\/s00405-021-07010-1","article-title":"Post-COVID-19 rhino-orbito-cerebral mucormycosis: A new addition to challenges in pandemic control","volume":"279","author":"Mitra","year":"2022","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"10.25259\/SNI_374_2022\/ref-12","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jocn.2004.07.015","article-title":"Rhinocerebral mucormycosis: Perineural spread via the trigeminal nerve","volume":"12","author":"Orguc","year":"2005","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_374_2022\/ref-13","doi-asserted-by":"crossref","first-page":"2965","DOI":"10.1007\/s00405-021-07106-8","article-title":"Mucormycosis in COVID-19 pandemic and its neurovascular spread","volume":"279","author":"Pal","year":"2022","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"10.25259\/SNI_374_2022\/ref-14","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1111\/myc.13338","article-title":"COVID-19-associated mucormycosis: An updated systematic review of literature","volume":"64","author":"Pal","year":"2021","journal-title":"Mycoses"},{"key":"10.25259\/SNI_374_2022\/ref-15","first-page":"20150448","article-title":"Angioinvasive rhinocerebral mucormycosis with complete unilateral thrombosis of internal carotid artery-case report and review of literature","volume":"2","author":"Patil","year":"2016","journal-title":"BJR Case Rep"},{"key":"10.25259\/SNI_374_2022\/ref-16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12070-022-03080-7","article-title":"Are low serum Vitamin D levels a risk factor for advent of COVID-19 associated rhinocerebral mucormycosis: A preliminary case control study","author":"Popli","year":"2022","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"10.25259\/SNI_374_2022\/ref-17","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s13760-021-01840-w","article-title":"Mucormycosis in COVID-19 patients: Predisposing factors, prevention and management","volume":"122","author":"Rudrabhatla","year":"2022","journal-title":"Acta Neurol Belg"},{"key":"10.25259\/SNI_374_2022\/ref-18","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4103\/ijo.IJO_1565_21","article-title":"Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India collaborative OPAI-IJO study on mucormycosis in COVID-19 (COSMIC), report 1","volume":"69","author":"Sen","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"10.25259\/SNI_374_2022\/ref-19","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s12223-021-00934-5","article-title":"Mucormycosis: Risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic","volume":"67","author":"Sharma","year":"2022","journal-title":"Folia Microbiol (Praha)"},{"key":"10.25259\/SNI_374_2022\/ref-20","doi-asserted-by":"crossref","first-page":"e245756","DOI":"10.1136\/bcr-2021-245756","article-title":"Rhino-orbito-cerebral mucormycosis causing cranial nerve abscess in post-COVID-19 status","volume":"14","author":"Sharma","year":"2021","journal-title":"BMJ Case Rep"},{"key":"10.25259\/SNI_374_2022\/ref-21","doi-asserted-by":"crossref","first-page":"bcr2013200811","DOI":"10.1136\/bcr-2013-200811","article-title":"Rhinocerebral mucormycosis in a patient with Type 1 diabetes presenting as toothache: A case report from Himalayan region of India","volume":"2013","author":"Singh","year":"2013","journal-title":"BMJ Case Rep"},{"key":"10.25259\/SNI_374_2022\/ref-22","doi-asserted-by":"crossref","first-page":"101238","DOI":"10.1016\/j.mycmed.2021.101238","article-title":"Surgical and medical management of ROCM (Rhino-orbito-cerebral mucormycosis) epidemic in COVID-19 era and its outcomes a tertiary care center experience","volume":"32","author":"Soni","year":"2022","journal-title":"J Mycol Med"},{"key":"10.25259\/SNI_374_2022\/ref-23","doi-asserted-by":"crossref","first-page":"3728","DOI":"10.4103\/ijo.IJO_1316_21","article-title":"Mucormycosis in COVID-19 patients","volume":"69","author":"Sundaram","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"10.25259\/SNI_374_2022\/ref-24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12070-021-02986-y","article-title":"A proposed grading system and experience of COVID-19 associated rhino orbito cerebral mucormycosis from an Indian tertiary care center","author":"Vaid","year":"2021","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"10.25259\/SNI_374_2022\/ref-25","first-page":"e21061","article-title":"Rhinocerebral mucormycosis with brain abscess presenting as status epileptucus in a COVID-19-infected male: A calamitous complication","volume":"14","author":"Verma","year":"2022","journal-title":"Cureus"},{"key":"10.25259\/SNI_374_2022\/ref-26","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00277-016-2837-1","article-title":"Epileptic seizures and rhinocerebral mucormycosis during blinatumomab treatment in a patient with biphenotypic acute leukemia","volume":"96","author":"Vogt","year":"2017","journal-title":"Ann Hematol"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/surgical-management-of-post-covid-invasive-rhino-orbito-cerebral-mucormycosis-and-its-outcomes-role-of-neurosurgeons-in-a-tertiary-care-center\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/surgical-management-of-post-covid-invasive-rhino-orbito-cerebral-mucormycosis-and-its-outcomes-role-of-neurosurgeons-in-a-tertiary-care-center\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T07:12:12Z","timestamp":1659683532000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/surgical-management-of-post-covid-invasive-rhino-orbito-cerebral-mucormycosis-and-its-outcomes-role-of-neurosurgeons-in-a-tertiary-care-center\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,5]]},"references-count":26,"alternative-id":["10.25259\/SNI_374_2022"],"URL":"https:\/\/doi.org\/10.25259\/sni_374_2022","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,5]]},"article-number":"335"}}