Case Of Skull Base Osteomyelitis Research Articles

Role of surgery along with antimicrobials in refractory skull base osteomyelitis-A prospective observational study.

Study aimed to ole of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO). A prospective observational study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. The study population comprised 35 patients refractory to systemic antimicrobials of at least 4 weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment. According to our study, relief of pain was faster in the surgical group (1.66 against 4.57 months) with statistical significance (p < 0.001). Relief of symptoms (p < 0.001), radiological improvement (p = 0.001), and normalising of inflammatory markers (p < 0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9.2 months in the surgical group compared to 11.3 months in the medical group (p = 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%). The treatment response in selected patients of refractory SBO who underwent surgery along with antimicrobials was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.

Challenges in Diagnosis and Management of Skull Base Osteomyelitis: A Case Series

Background and Importance: Skull base osteomyelitis (SBO) is a complex disease process often confused with malignancy due to clinical and radiological masquerade. Extensive changes have recently occurred in the clinical course and management of the disease, attributed to improvements in neurosurgical procedures, diagnostic modalities, and the introduction of new antibiotics and management techniques thus reducing the associated morbidities and mortalities. However, SBO continues to pose a major challenge in the form of early diagnosis and management and can be the cause of devastating complications and high fatality associated with the disease. Case Presentation: Here we provide the clinical profile, investigation, management, and outcome of 5 cases of SBO, all of whom were thoroughly examined for the neurological deficit, complete blood count, inflammatory markers, and radiographic imaging. Biopsy and microbiological culture reports were collected and patients were followed up. Conclusion: Early diagnosis and culture-specific antibiotic treatment have been shown to provide good outcomes. Due to its rarity, large case series of SBO are insufficiently found in the literature.

A Case of Skull Base Osteomyelitis Caused by Invasive Fungal Infection from an Unknown Focus

A Case of Skull Base Osteomyelitis Caused by Invasive Fungal Infection from an Unknown Focus

A Case of Skull Base Osteomyelitis Caused by Fungi

A Case of Skull Base Osteomyelitis Caused by Fungi

A case of skull base osteomyelitis revealed by nasopharyngectomy

A case of skull base osteomyelitis revealed by nasopharyngectomy

The role of imaging in skull base osteomyelitis — Reviewed

PurposeSkull base osteomyelitis (SBO) is difficult to diagnose due to a wide array of clinical presentations. It can be life threatening if not treated promptly.The objective of this study is to identify the various neck spaces involved in skull base osteomyelitis, correlate them with the possible source of infection and identify the related complications. MethodsEighty nine consecutive either culture proven cases of skull base osteomyelitis, or culture negative cases with inflammation on histopathology responding to antibiotic therapy, presenting at a single non-government hospital in south India between January 2016 and December 2018 were included in this study. Images were reviewed by two radiologists and imaging findings were documented by consensus. ResultsInvolvement of the parotid space, retromastoid space and (temporomandibular) TM joint was associated with otogenic source of infection (p value < 0.05); while, retropharyngeal/prevertebral involvement was associated with sphenoid and nasopharyngeal sources (p value < 0.05). Complications such as cavernous sinus thrombosis (p value = 0.023) and ICA involvement (p value = 0.014) were more commonly seen with central skull base osteomyelitis. Abscess formation was seen in all three groups of patients without a significant difference between the groups. ConclusionImaging plays an important role in determining the possible source of infection by identifying the involved neck spaces and this in turn can guide the clinician to a site for biopsy. Complications related to SBO can also be identified on imaging and can guide appropriate management.

A Rare Case of Skull Base Osteomyelitis Caused By E.Coli and Candida Albicans in A Patient with Gapo Syndrome: A Case Report

Skull base osteomyelitis is a very rare and life-threatening disease. It has significant mortality and morbidity though appropriate antibiotherapy. Here we report a case of atypical skull base osteomyelitis, which is rarely seen in infectious disease practice, caused by E.coli and Candida albicans in a patient with GAPO syndrome.

A Case of Skull Base Osteomyelitis in an Elderly Patient without Underlying Disease

A Case of Skull Base Osteomyelitis in an Elderly Patient without Underlying Disease

A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction.

Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

Two Cases of Skull Base Osteomyelitis with Malignant External Otitis

Two Cases of Skull Base Osteomyelitis with Malignant External Otitis

Central skull base osteomyelitis

Skull base osteomyelitis (SBO) most commonly results as a complication of otitis externa in diabetic patients. Central or atypical presentations, unrelated to aural pathology, have been documented, though restricted to small patient series or case reports. The current study systematically analyzed the literature to construct the clinical profile of this rare entity. Systematic review of case series. The MEDLINE database was searched for all published cases of central SBO. Four additional cases were included from the University of Texas Southwestern Medical Center. Statistical analysis was performed to identify trends affecting overall outcomes or differences in treatment. A total of 42 cases were included with mean age of 52 years and male:female ratio of 2.2:1. The most common presenting symptoms were headaches and cranial nerve palsies, including VI (31%), IX (29%), and X (29%). Staphylococcus aureus (21%) and Pseudomonas aeruginosa (19%) were the two most common causative pathogens. The mean duration of antimicrobial therapy was 21 weeks, with 55% requiring intravenous antibiotics for a mean duration of 6.9 weeks. Twenty of 42 patients (48%) received surgical biopsy for diagnosis, whereas 18 patients (43%) required adjunct surgical debridement. Women were more likely than men to require multiple courses of therapy (46% vs. 7%, P = .01). The overall mortality was 9.5%, with an additional 31% experiencing residual neurological dysfunction. Osteomyelitis of the central skull base poses significant challenges for timely and accurate diagnosis. Aggressive management with antimicrobials, coupled with surgical debridement in select cases, may avoid serious neurologic morbidity and mortality.

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

A 44-year-old man presented with a very rare case of skull base osteomyelitis manifesting as persistent diplopia. He initially had the symptom with fever after dental extraction. Biopsy from the cervix and upper pharynx performed in a previous hospital had showed negative findings by histological and bacterial examinations. Magnetic resonance (MR) imaging disclosed enhanced lesions in the right cavernous sinus, clivus, and right cervical regions. Computed tomography revealed osteolysis, and fluorodeoxyglucose positron emission tomography (FDG-PET) showed areas of increased uptake. Bacteriological examination of the isolated clival lesion disclosed Actinomyces israelii, and he was treated with intravenous penicillin, 18 million units a day for 6 weeks. MR imaging revealed reduction of intensity in the enhanced areas, and FDG-PET showed disappearance of the increased uptake. After 6 months of oral antibiotics administration, MR imaging disclosed disappearance of the enhanced lesions, and the patient had no sign of neurological deficits. Skull base osteomyelitis resembles neoplasm or inflammatory disease of this region in neurological and radiographic findings. The biopsy specimen should be ideally obtained from an isolated region, and prepared to identify a wide range of organisms and to differentiate other diseases. The serum level of C-reactive protein and FDG-PET are useful to follow up the efficacy of antibiotic therapy.

Mycobacterium Chelonae Infections Involving the Head and Neck

We describe the manifestations, diagnosis, and treatment of rare head and neck infections caused by Mycobacterium chelonae, including a case of maxillary osteitis and skull base osteomyelitis. A comprehensive literature search (MEDLINE from 1951; BIOSIS from 1969; EMBASE from 1980) was performed for the presentation, diagnostic evaluation, and outcomes of patients with M chelonae infections. We report 4 cases of M chelonae infection, including a nasal abscess following septorhinoplasty with a cartilaginous graft, a case of chronic unilateral nasal obstruction, and the first reported cases of skull base osteomyelitis and maxillary osteitis secondary to M chelonae. All 4 cases involved immunocompetent individuals. Mycobacterium chelonae should be considered in cases of abscesses that persist despite broad-spectrum intravenous antibiotics, and in cases of maxillary sinusitis with bony involvement that do not respond to traditional treatment methods.

Nutzen der HBO bei der Therapie der fortgeschrittenen Schädelbasisosteomyelitis

The therapy of skull base osteomyelitis (SBO) is still challenging. Standard therapy includes the use of antibiotics, local treatment and surgical removal of necrotic bone and tissue. This study reports on the value of adjuvant hyperbaric oxygen therapy with respect to the functional outcome in SBO. Furthermore diagnostic signs especially on imaging are elaborated. The retrospective study included all cases of SBO treated between July 2002 and November 2006 in our department. Clinical data, microbiology, laboratory and radiological findings were reviewed. Treatment modality data, especially the use of adjuvant hyperbaric oxygen therapy (HBO) were analysed. The outcome with regard to neurological or functional deficit was assessed and the value of adjuvant HBO therapy was evaluated in comparison with the literature. In the given time period ten patients with SBO could be selected. The presumption diagnosis based on CT and/or MRI in first line. It was confirmed by histology in all cases. Treatment included high dose antibiotics, surgical debridement and adjuvant HBO therapy. Cure rate of treated patients was 8/8, regarding inflammatory signs. Two patients refused any further therapy during the course, in both the outcome was fatal. Functional recovery of cranial nerve deficits could be reached in 6/8. Two patients had residual cranial nerve palsies. The outcome was mainly influenced by the treatment modality and duration of cranial nerve involvement. Adjuvant hyperbaric oxygen therapy has been proved to be highly effective in the treatment of advanced SBO. Cranial nerve palsies can recover completely under optimized treatment including adjuvant HBO therapy.

Skull base osteomyelitis after maxillectomy: a rare complication

We report a case of skull base osteomyelitis that presented 4–8 weeks after a level 2 maxillectomy for a plexiform ameloblastoma of the right posterior maxilla. This is an extremely rare complication, and we know of no previously reported cases that developed after maxillectomy. We summarise the presentation, differential diagnosis and management.

A case of skull base osteomyelitis with cholesteatoma resulting in outcome of death

A case of skull base osteomyelitis with cholesteatoma resulting in outcome of death

Two Cases of Skull Base Osteomyelitis after Mastoidectomy

Skull base osteomyelitis is originated from inappropriately treated chronic infections near the skull base. If diagnosis and treatment are delayed, it occasionally causes multiple cranial nerve palsy, with the mortality rate being as high as 60%. Skull base osteomyelitis typically evolves as a complication of external otitis in diabetic patients, so it has been thought as a synonym for malignant external otitis. However, the routes of infection are diverse. We experienced two patients of atypical skull base osteomyelitis after mastoidectomy. It is an unusual complication of mastoidectomy, so we report about these cases. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:279-83)

Cervicogenic Headache from Skull Base Osteomyelitis -A case report-

Skull base osteomyelitis is a rare but life-threatening complication of inflammation of the ear. The authors present a case of skull base osteomyelitis of unknown etiology in a non-diabetic patient who presented with unilateral posterior neck and occipital headache mimicking cervicogenic headache.

Otogenic skull base osteomyelitis caused by invasive fungal infection

Otogenic skull base osteomyelitis (SBO) of fungal etiology is a very rare but life-threatening complication of inflammatory processes of the ear. The authors present a case of otogenic SBO caused by Aspergillus flavus in a 65-year-old man with a fatal course. Because of the encountered difficulties with the proper diagnosis and treatment, the authors reviewed the literature on the subject.

Salmonella osteomyelitis of the skull base

A case of skull base osteomyelitis caused by Salmonella is reported. The patient, a diabetic immunosuppressed man, had an insidious presentation of nasopharyngeal and cranial nerve findings. His radiologic studies showed a striking destruction of the skull base. He died despite antibiotic therapy. Relevant literature is discussed.