Background Central skull-base osteomyelitis (CSBO) represents a life-threatening complication of external ear canal infection. Computed tomography (CT) and magnetic resonance imaging (MRI) play key roles in assessment of CSBO progression. Methods Twelve patients with CSBO were included in a retrospective clinical study. In total, 62 scans (30 CTs and 32 MRIs) were performed to evaluate the extent of inflammatory changes. The scans were read independently by two radiologists specialised in imaging of the head and neck. The regions under the skull base were specified using the online Anatomy Atlas of the skull base. To clarify the timeline, the time period was divided into four parts, and inflammatory changes in the skull-base regions were tracked. Data were statistically analysed. Results In early stages of the disease, CT scan detects inflammatory changes closely related to the stylomastoid foramen and medially to the posterior belly of the digastric muscle, changes which have been proved to be crucial for the diagnosis of CSBO. Later the infection spreads to the contralateral side causing demineralisation of the bones. Conclusion Imaging methods play a crucial role not only in establishing the diagnosis, but also in anticipating the direction of infection spread underneath the skull base.

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Introduction: By definition from the literature, Grisel’s syndrome is described as non-traumatic rotational atlantoaxial instability between C1 and C2 vertebrae. It can occur during an infection of a soft tissue in the cervicocranial region or after an operation in the ENT region. Because of the frequent occurrence after operations, we inclined to the definition which includes a traumatic subluxation as a cause of origin, and it’s not defined as non-traumatic only. The instability manifests itself with abnormal head posture that is called torticollis. Increased incidence in adolescence is more common because of a greater ligamentous laxity of the joint capsules, increased perfusion of antlantoaxial regions and longer alar ligaments. In this article, the case of a child with Grisel’s syndrome after adenotomy is described. The pathophysiology, symptomatology, diagnostic management and treatment are discussed. Keywords: Grisel’s syndrome – torticollis – atlantoaxial instability – adenotomy

Spontaneous meningoencephaloceles are often associated with cerebrospinal fluid leak and intracranial hypertension. There is a data scarcity concerning the need for insertion of a cerebrospinal diversion device in these situations. Therefore, we provided an analysis of our patients with spontaneous skull base meningoencephaloceles (MEC) whether their definitive surgical treatment requires management of elevated intracranial pressure (ICP) or not. Retrospective evaluation and data collection of 10 subjects with spontaneous MEC was held. Among others, attention was paid to measuring of ICP, prior interventions, treatment with acetazolamide, characteristics for long term elevated ICP, etc. Our own indications for cerebrospinal fluid (CSF) diversion and use of postoperative external lumbar drain (ELD) underwent analysis as well. The sphenoid region was the most common location of MEC. CSF leak was diagnosed in all subjects. The most common graphical signs of elevated ICP were empty sella and arachnoid pits, both of which were presented in 90% of cases. A lumbar puncture with opening pressure measurement was performed in 7 patients. Ventriculoperitoneal shunt insertion was indicated in 4 cases prior to and in two cases after skull base repair. Two postoperative CSF leaks were managed with ELD and subsequent shunt installation. Spontaneous MECs are often associated with CSF leak. The ICP assessment should be a standard of care to ensure MEC operative repair success. Insertion of a CSF diversion device must be considered where direct or indirect signs of ICH are presented.