Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

Abstract

Objectives: Based on current evidence, this systematic review focuses on various grey areas related to these patients' diagnosis, management and follow-up in central skull base osteomyelitis (CSBO). Study design: A systematic review of all case reports and observational studies. Methods: We systematically searched PubMed, Scopus database, Cochrane database, UK clinicaltrails.gov registry, and WHO ICTRP and included all reports as per our inclusion criteria. Data was analyzed systematically, and we made essential observations. Results: Out of 179 articles, 25 were selected according to inclusion criteria and quality assessment. Among the 44 patients, refractory headache (95%) was the most common presentation, followed by cranial nerve paralysis (82%) and Pseudomonas (32%) as the most common bacteria. Contrary to the available literature the disease cure was worse in those who underwent targeted biopsy (64% VS 36%, P = 0.023) and surgical debridement (61% vs 39%, P = 0.013) in the late stages of the disease. Conclusions: Otogenic osteomyelitis can spread to central skull bones in the absence of obvious ear symptoms. Early diagnosis and intervention of CSBO before progression to late stages can help decrease significant morbidity and mortality.