Recurrent disease is common in allergic fungal rhinosinusitis (AFR) and close follow-up is necessary. • Both optimal medical and surgical therapy are needed for the adequate treatment of AFRS to minimize recurrence. • Care should be taken to avoid dural resection to prevent future intracranial dissemination of disease. • Image-guided surgery is useful for revision surgery for AFRS in the face of altered anatomical landmarks. • Recurrence after treatment of AFRS is common.
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