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Central skull base osteomyelitis: an emerging clinical entity.

Andrew K Johnson1, Pete S Batra

  • 1Department of Otolaryngology-Head and Neck Surgery and Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

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Summary

Central skull base osteomyelitis (SBO) often presents atypically, with headaches and cranial nerve palsies being common. Aggressive antimicrobial and surgical treatment can reduce mortality and neurological deficits in SBO patients.

Keywords:
Sinusdiabetesendoscopyinfectionosteomyelitisskull base

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Otolaryngology

Background:

  • Skull base osteomyelitis (SBO) is often a complication of otitis externa in diabetic patients.
  • Atypical presentations of SBO, unrelated to ear infections, are rare and poorly documented.
  • This study systematically reviews the literature to define the clinical profile of central SBO.

Purpose of the Study:

  • To construct the clinical profile of central skull base osteomyelitis.
  • To identify trends in presentation, pathogens, treatment, and outcomes.
  • To analyze factors influencing patient outcomes.

Main Methods:

  • Systematic review of case series.
  • MEDLINE database search for central SBO cases.
  • Inclusion of four additional cases from a medical center.
  • Statistical analysis of trends and treatment differences.

Main Results:

  • 42 cases analyzed (mean age 52, male:female 2.2:1).
  • Common symptoms: headaches, cranial nerve palsies (VI, IX, X).
  • Key pathogens: Staphylococcus aureus, Pseudomonas aeruginosa.
  • Treatment: mean 21 weeks antimicrobials (6.9 weeks IV).
  • Surgery: 48% biopsy, 43% debridement.
  • Women required more therapy courses (46% vs 7%, P=.01).
  • Outcomes: 9.5% mortality, 31% residual neurological dysfunction.

Conclusions:

  • Central SBO diagnosis is challenging.
  • Aggressive antimicrobial therapy is crucial.
  • Surgical debridement benefits select cases.
  • Timely management can mitigate severe morbidity and mortality.