Suspected Skull Base Aspergillosis: Endoscopy vs Radiology

Background & Purpose: Anterior skull base aspergillosis is usually the off shoot of PNS disease pathology, providing a potential site to establish the diagnosis. The purpose of this study was to evaluate the role of PNS endoscopy in cases of suspected skull- base aspergillosis when radiology is non-contributory.

Methods: Since January 2007, a total of 53 patients harboring skull base masses underwent PNS endoscopic evaluation to establish the diagnosis. All patients had PNS CT scans and MRI scans involving anterior skull base.

Results: Twenty seven patients had no evidence of disease on PNS CT scans / MRI, while rest 26 patients showed variable mucosal thickening suggestive of disease process. Endoscopy findings contributed in establishing the diagnosis of aspergillosis in 24 cases (disease involving PNS on radiology), while diagnosis could be established in 23 patients even when radiology was non-contributory.

Conclusion: In all cases of suspected skull base aspergillosis, endoscopic evaluation of PNS and skull base should be performed to establish the diagnosis irrespective of radiological findings of PNS.