Osteomyelitis of the base of the skull

Abstract

Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.

SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

“…Typical skull base osteomyelitis involves the temporal bone and is usually a complication of malignant otitis externa in a diabetic/immunocompromised patient due to Pseudomonas aeruginosa. Osteomyelitis of the skull can result as a complication of infective paranasal sinusitis, trauma, tooth extractions, chronic mastoiditis, malignant otitis externa and various surgical procedures such as surgical debridement or drainage of a mastoid abscess [5,6]. Conventional 99m Tc MDP bone scan planar images are often unable to localize the exact site of infection inspite of being a sensitive technique for the diagnosis of osteomyelitis.…”

Atypical skull base osteomyelitis in the intensive care unit: A case report

“…[1] It often presents with non-specific symptoms such as persistent headache, with the eventual development of cranial neuropathy. It is most commonly seen in middle-aged or elderly males, with an underlying immunocompromised state such as diabetes mellitus, corticosteroid use, Human Immunodeficiency Virus (HIV) infection or chronic inflammatory sphenoid sinus disease.…”

“…Typically, skull base osteomyelitis is preceded by a destructive malignant otitis externa, but atypical cases which present without aural symptoms are also reported. [1,2,6] In a study of forty-two such atypical cases, headaches, facial pain and palsy of cranial nerves were the commonest presenting features. [3] The radiological findings of bony erosion of base of skull and soft tissue swellings often raise a suspicion of a malignant process such as nasopharyngeal carcinoma or skull base metastases.…”

“…It initially involves the lateral part of the temporal bone and extends to the centre of base of skull, specifically to the petrous apex and the clivus. [1] As such, the patient initially presents with auditory symptoms including persistent ear discharge, ear pain and loss of hearing, or with cranial nerve palsies involving the oculomotor (III), trigeminal (V), abducens (VI), facial (VII), vestibulocochlear (VIII), glossopharyngeal (IX), vagus (X), accessory (XI) and hypoglossal (XII). [2,3] This disease usually occurs in diabetes mellitus and elderly patients with high cerebrocardiovascular risks.…”

Atypical Osteomyelitis of the Skull Base and Craniovertebral Junction Caused by Actinomyces Infection -Case Report-

“…Various organisms have been reported as causative pathogens of the skull base osteomyelitis, including Pseudomonas aeruginosa, mycobacterium, aspergillus, and candida in the typical disease, 4,5,7,10) and Staphylococcus aureus, coagulase-negative staphylococcus, and pseudomonas in the atypical disease. 7,10) Anaerobes are frequently the cause of bacterial infection in endogenous origin, but are very difficult to identify from infectious sites, and are often overlooked.…”