Background Rhino-orbito-cerebral mucormycosis (ROCM) is an aggressive angioinvasive fungal infection that predominantly affects immunocompromised patients. During the COVID-19 pandemic, India experienced a marked surge in ROCM, attributed to SARS-CoV-2–related immune dysregulation, corticosteroid exposure, and uncontrolled diabetes. Intracranial extension represents the most severe form and is associated with high mortality. Objective To analyze the clinical profile, radiological features, surgical management, and outcomes of patients with post-COVID rhino-orbito-cerebral mucormycosis with intracranial extension undergoing neurosurgical intervention. Methods A retrospective observational study was conducted at a tertiary referral center between April 2021 and June 2022. Among 316 patients diagnosed with mucormycosis, 70 had intracranial involvement. Ten patients with surgically amenable lesions underwent neurosurgical intervention. Demographic, clinical, radiological, operative, and outcome data were analyzed. Results All patients had recent COVID-19 infection, with diabetes mellitus and corticosteroid exposure as the predominant risk factors. Frontal lobe abscess was the most frequent intracranial presentation, commonly associated with ethmoid and frontal sinus disease. Early neurosurgical drainage or excision combined with systemic antifungal therapy resulted in favorable neurological recovery and complete radiological resolution on follow-up imaging. Conclusion Post-COVID cerebral mucormycosis is a life-threatening condition requiring prompt recognition and aggressive management. Early neurosurgical intervention, combined with antifungal therapy and strict metabolic control, plays a critical role in improving outcomes. Multidisciplinary management is essential to reduce morbidity and mortality in advanced ROCM,

Mucormycosis, COVID-19, Brain Abscess, Neurosurgical Procedures, Antifungal Agents, Diabetes Mellitus.