Central or Atypical Skull Base Osteomyelitis: Diagnosis and Treatment

Abstract

Objective: We report cases of central or atypical skull base osteomyelitis and review issues related to the diagnosis and treatment. Methods: The four cases presented, which were drawn from the Oxford, United Kingdom, skull base pathology database, had a diagnosis of central skull base osteomyelitis. Results: Four cases are presented in which central skull base osteomyelitis was diagnosed. Contrary to malignant otitis externa, our cases were not preceded by immediate external infections and had normal external ear examinations. They presented with headache and a variety of cranial neuropathies. Imaging demonstrated bone destruction, and subsequent microbiological analysis diagnosed infection and prompted prolonged antibiotic treatment. Conclusion: We concluded that in the diabetic or immunocompromised patient, a scenario of headache, cranial neuropathy, and bony destruction on imaging should raise the possibility of skull base osteomyelitis, even in the absence of an obvious infective source. The primary goal should still be to exclude an underlying malignant cause.

Diffusion MR Imaging Features of Skull Base Osteomyelitis Compared with Skull Base Malignancy

“…Similarly, the radiologic findings may be subtle early in the disease and may include signal-intensity changes, enhancement, and an infiltrating pattern indistinguishable from neoplastic processes affecting the skull base such as advanced NPC, lymphoma, and metastatic disease. [4][5][6][7][8] The purpose of this study was to investigate the DWI findings that would allow prompt and accurate diagnosis of SBO in a series of patients.…”

“…5,8,9,17 However, for the inexperienced reader, the appearance of the soft tissues (especially on T1-weighted images) and accompanying bone marrow changes may suggest a skull base malignancy such as advanced NPC, metastatic disease, or lymphoma. [5][6][7][8] We, therefore, sought to evaluate the value of DWI as a possible technique to assist in the differential diagnosis.…”

Central Skull Base Osteomyelitis: Diagnostic Dilemmas and Management Issues

“…A delay was also reported by Cavel et al [8] and was attributed to lack of specific signs as well as to the clinical and imaging traits shared by CSBO and malignant processes. Since the imaging findings frequently mimic malignancy [11] accurate histological diagnosis becomes all the more important. We had obtained tissue biopsy in Cases 1, 2 and 3 where malignancy had been excluded.…”

Are CT and MRI Scanning Reliable in Diagnosing Otogenic Skull Base Osteomyelitis in Non-Immunocompromised Elderly Patients? A Case Series and Review of the Literature

“…This is especially useful in patients with cranial nerve palsies secondary to SBO. 16,17 Most abnormalities on MRI exhibit a low signal on T1-weight images and a high signal on T2-weighted images, indicating replacement of the normal fatty marrow. 18 However, differentiating a skull base malignancy from SBO on MRI can be challenging.…”

“…19 Given that neither test is diagnostic, most studies recommend a CT and MRI together in order to obtain as much information as possible. 13,16,17,20 Another imaging option is a radionucleotide scan, including 99m Tc or gallium-67 bone scans. Though not standard practice at present, these imaging modalities have some advantages over CT and MRI.…”