Invasive Skull Base Mucormycosis: New Perspectives

Review by L Flood
Middlesbrough, UK

At a glance it is obvious that this is a very attractively presented book, which, for such an unpleasant condition, might sound a bit odd. It functions both as an atlas and also as a very well edited, authoritative, multi-author text. Colour reproduction of endoscopic surgery is prolific and is of excellent print quality. There is many a CT, especially those with 3D reconstruction, and MRI scans which are well labelled and carry a clear legend to the illustrations. On rare occasions there has been an attempt to “pack in too much”, resulting in over 20 slices in a single small illustration, which prove indecipherable. Fortunately this is compensated by the reproduction of most of these in the many accompanying videos.

The opening chapter reminds us that mucormycosis predates the COVID-19 era and describes the traditional risk factors, the role of iron (who knew that? I did not) and of host immunity. Successive waves of COVID-19 saw the massive rise in prevalence of such a destructive fungal disease, especially throughout India, where courageous surgeons rapidly developed a unique expertise. The opening paragraph to Chapter 10, on a surgical staging system, tells us that “its prevalence is 80 times higher in India than in developed nations” (their phrase, not mine. This is a country that has soft landed on the moon after all). Again we learn that “India has the second largest diabetic population in the world” hence the scale of the problem.

There are chapters here that will appeal to rhinologists and skull base, maxillofacial or orbital surgeons, plus of course anaesthetists. Post operative medical therapy and treatment of complications draw the text towards its close, but a particularly well thought-out final chapter, “Exploring the Future”, covers such topics as advances in imaging, neuronavigation, pharmacology, orbital reconstruction and antiviral vaccine development.

The book’s greatest appeal will of course be to surgeons from the subcontinent of India, while most of us can just be glad to be spared this challenge. The editors and publishers are to be congratulated on producing a book that I had expected, as a reviewer, to find hard going frankly. I did not and would highly recommend this to trainees and experienced surgeon who are likely to encounter this and, let us remember, this disease is not confined to India. It is just that it is there that all the expertise has developed.

Amazon Link: Invasive Skull Base Mucormycosis: New Perspectives
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