Skull Osteomyelitis

Abstract

Bone lesions resembling tertiary syphilis caused by Treponema pallidum or another of the treponematoses have been observed in nearly every Andean culture from Peru and Chile, dating back nearly 8000 years (Gerstzen et al., 1998). The lesions are similar in each case, with periostitis, osteitis, and osteomyelitis attacking the skull and the long bone, particularly the tibia. This tibial involvement results in the classic "saber shin". Several of the skulls observed with such lesions had been "treated" during life by repeated trephination using a scraping technique. 2.1.2 Greek and early Byzantine period The intellectual evolution of neurological surgery originated in the golden age of Greece with the founding of the Alexandrian school in 300 BC. Because of both sporting injuries, in particular gladiator injuries, and wars, head injuries appear to have been plentiful, and provided opportunities to develop neurosurgical skills (Goodrich & Flamm, 2011). In this early era of medicine, the risk of infection, lack of antiseptic technique, and minimal anesthesia prevented generations of surgeons from performing any serious or aggressive surgical intervention for head injury (Goodrich & Flamm, 2011). Galen of Pergamon (AD 129-200) detailed a safer and more reliable use of the trephine, and in particular argued for continuous irrigation during trephination to avoid delivering excessive heat and injury to the underlying brain (Goodrich, 2005). Paul of Aegina (AD 625-690), trained in the Alexandrian school, was the last great Byzantine physician. His wound management was quite sophisticated for prevention of infection. He used wine (helpful in antisepsis, although this concept was then unknown) (Goodrich, 2005). 2.1.3 Medieval Europe Inventive medieval surgeon Theodoric Borgognoni of Cervia (1205-1298) is remembered as a pioneer in the use of the aseptic technique-not the "clean" aseptic technique of today, but rather a method based on avoidance of "laudable pus". He attempted to discover the ideal conditions for good wound healing, and concluded that they comprised control of bleeding, removal of contaminated or necrotic material, avoidance of dead space, and careful application of a wound dressing bathed in wine (Goodrich & Flamm, 2011). Control of bleeding, removal of contaminated or necrotic material, and avoidance of dead space are principles that can also apply in today's neurosurgical operations. He also argued for primary closure of all wounds when possible and avoiding "laudable pus" (Goodrich & Flamm, 2011). Lanfranchi of Milan (1250-1306) noted that the head should be shaved prior to surgery to prevent hair from getting into the wound and interfering with primary healing. Today, most neurosurgeons also shave hair before an operation. However, the time of shaving is currently controversial. When dealing with depressed skull fractures, Lanfranchi advocated putting wine into the depression to assist healing (Goodrich & Flamm, 2011). Guy de Chauliac (1300-1368) was clearly the most influential European surgeon of the ...

Calvarial Tuberculosis With Intracranial Tuberculomas: A Rare Association

“…Isolated calvarial tuberculosis is rare due to paucity of lymphatics [1] and little cancellous component in the calvarial bones [3]. The frontal and parietal bones, having greater area of diploic space and cancellous bones are more vulnerable [4,5].…”

“…The CT picture of tuberculous osteomyelitis is not very specific. Pyogenic osteomyelitis, calvarial metastases, myeloma, hemangioma, giant cell tumor or even an aneurysmal bone cyst and Langerhans cell histiocytosis form the important differential diagnoses [1,3,9]. However MRI with contrast studies combined with MRS are more informative.…”

“…Though tuberculosis is very common especially in the developing countries like India, in both immunocompetent and immunocompromised set of patients, tuberculosis of flat bones of skull is a rare entity and its association with tuberculomas is rarer still, with only a few reports in literature. The overall incidence of skull tuberculosis is approximately 1/10,000 cases of tuberculosis [1,2]. Here, we are reporting a rare case of calvarial tuberculosis with multiple intracranial tuberculomas without focus of infection elsewhere.…”