Outcome Of Total Surgical Debridement Of Covid Associated Skull base Mucormycosis Based on a New Surgical Staging System: Evidence From A Cohort Study

ABSTRACT Purpose To propose a surgical staging system with management protocol for post-covid Rhino-Orbito-Cerebral Mucormycosis (ROCM) with central skull base osteomyelitis. Methods A prospective cohort study of post-covid ROCM patients between May 2021 and January 2022. Patients were assessed radiologically and staged from I to V. Follow up period was 6 to 18 months and the surgical outcome was assessed. Results Total of 193 patients (129 primary and 64 revision). Maxilla was found to be the epicenter of anterior disease (69.3%) and pterygoid wedge, the epicenter of posterior disease (85.6%). More than 65% of our patients, at the time of presentation, presented with ROCM with involvement of the central skull base. Intracranial disease was noted in 13.9% of patients and the mortality rate was 6.2 %. Conclusion This staging system provides a systematic step-by-step protocol for the management of ROCM, with emphasis on meticulous disease clearance at the central skull base.