Adjuvant Hyperbaric Oxygen Therapy

Abstract

Adjuvant hyperbaric oxygen therapy (HBOT) for cranial osteomyelitis seems very helpful. It may improve successful treatment by reversing tissue hypoxia, enhancing phagocytic killing of aerobic microorganisms, and stimulating neomicroangiogenesis. However, the limited availability of this technique makes it not practical for widespread concern. There is effectively sparse neurosurgical literature about HBOT applied on cranial osteomyelitis and few publications explain clearly their inclusion criteria and therapeutic protocol. Generally, and based on a literature review, treatment of cranial osteomyelitis with the combination of antimicrobial drugs, surgical debridement and HBOT appears to maximize the potential for infection clearance. HBOT cannot be recommended as a solitary treatment modality in the management of skull bone infection. However, HBOT should be considered as adjuvant therapy for the treatment of refractory osteomyelitis of the skull combined with antimicrobial therapy prior to sustaining major cranial debridement. No specific recommendations can be prescribed for the total number of HBOT sessions. This duration must be judged depending on the clinical outcome of each patient (usually between 20 and 40 sessions, five to seven times per week).