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Skull Base Osteomyelitis
Philip R. Chapman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Skull base osteomyelitis (SBO)
              • Definitions

                • SBO: Severe infection of temporal, sphenoid, &/or occipital bone that results in osseous destruction &/or marrow space involvement
                • Typical SBO: Infection involves temporal bone initially, occurs most often as result of necrotizing external otitis (NEO)
                  • Many authors consider part of spectrum of NEO
                  • SBO can occur secondary to other infections related to temporal bone including otomastoiditis or petrous apicitis
                  • Can occur secondary to trauma or surgery of temporal bone
                  • Pseudomonas aeruginosa is most common pathogen
                • Atypical SBO: Occurs secondary to invasive sinusitis or deep face infections, not temporal bone
                  • No recent history of NEO or otomastoiditis
                  • Also referred to as central skull base osteomyelitis
                  • Less common than typical SBO
                  • Can be idiopathic, without specific localized head & neck infection

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Harrison L et al: Granulomatosis with polyangiitis affecting the skull base and manifesting as spontaneous skull base osteomyelitis. BMJ Case Rep. 2016, 2016
                                            2. Orioli L et al: Central skull base osteomyelitis: a rare but life-threatening disease. Acta Clin Belg. 70(4):291-4, 2015
                                            3. Johnson AK et al: Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 124(5):1083-7, 2014
                                            4. Bag AK et al: Neuroimaging: intrinsic lesions of the central skull base region. Semin Ultrasound CT MR. 34(5):412-35, 2013
                                            5. Ganhewa AD et al: A diagnostic dilemma of central skull base osteomyelitis mimicking neoplasia in a diabetic patient. BMJ Case Rep. 2013, 2013
                                            6. Spielmann PM et al: Skull base osteomyelitis: current microbiology and management. J Laryngol Otol. 127 Suppl 1:S8-12, 2013
                                            7. Adams A et al: Central skull base osteomyelitis as a complication of necrotizing otitis externa: Imaging findings, complications, and challenges of diagnosis. Clin Radiol. 67(10):e7-e16, 2012
                                            8. Blyth CC et al: Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 17(2):306-11, 2011
                                            9. Ozgen B et al: Diffusion MR imaging features of skull base osteomyelitis compared with skull base malignancy. AJNR Am J Neuroradiol. 32(1):179-84, 2011
                                            10. Borges A: Imaging of the central skull base. Neuroimaging Clin N Am. 19(4):669-96, 2009
                                            11. Clark MP et al: Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base. 19(4):247-54, 2009
                                            12. Lin YJ et al: Posterior fossa intracranial inflammatory pseudotumor: a case report and literature review. Surg Neurol. 72(6):712-6; discussion 716, 2009
                                            13. Carfrae MJ et al: Malignant otitis externa. Otolaryngol Clin North Am. 41(3):537-49, viii-ix, 2008
                                            14. Bouccara D et al: [Osteomyelitis of the skull base due to otologic or sinus infections. 5 cases.] Ann Otolaryngol Chir Cervicofac. 124(1):25-32, 2007
                                            15. Lee EJ et al: MR imaging of orbital inflammatory pseudotumors with extraorbital extension. Korean J Radiol. 6(2):82-8, 2005
                                            16. Singh A et al: Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg. 133(1):121-5, 2005
                                            17. Chang PC et al: Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol. 24(7):1310-6, 2003
                                            18. Chan LL et al: Imaging of mucormycosis skull base osteomyelitis. AJNR Am J Neuroradiol. 21(5): 828-31, 2000
                                            19. Slattery WH 3rd et al: Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am. 29(5):795-806, 1996
                                            20. Anielski R et al: [Surgical treatment of goiter in older people.] Wiad Lek. 42(10):633-5, 1989
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Skull base osteomyelitis (SBO)
                                                        • Definitions

                                                          • SBO: Severe infection of temporal, sphenoid, &/or occipital bone that results in osseous destruction &/or marrow space involvement
                                                          • Typical SBO: Infection involves temporal bone initially, occurs most often as result of necrotizing external otitis (NEO)
                                                            • Many authors consider part of spectrum of NEO
                                                            • SBO can occur secondary to other infections related to temporal bone including otomastoiditis or petrous apicitis
                                                            • Can occur secondary to trauma or surgery of temporal bone
                                                            • Pseudomonas aeruginosa is most common pathogen
                                                          • Atypical SBO: Occurs secondary to invasive sinusitis or deep face infections, not temporal bone
                                                            • No recent history of NEO or otomastoiditis
                                                            • Also referred to as central skull base osteomyelitis
                                                            • Less common than typical SBO
                                                            • Can be idiopathic, without specific localized head & neck infection

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Harrison L et al: Granulomatosis with polyangiitis affecting the skull base and manifesting as spontaneous skull base osteomyelitis. BMJ Case Rep. 2016, 2016
                                                                                      2. Orioli L et al: Central skull base osteomyelitis: a rare but life-threatening disease. Acta Clin Belg. 70(4):291-4, 2015
                                                                                      3. Johnson AK et al: Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 124(5):1083-7, 2014
                                                                                      4. Bag AK et al: Neuroimaging: intrinsic lesions of the central skull base region. Semin Ultrasound CT MR. 34(5):412-35, 2013
                                                                                      5. Ganhewa AD et al: A diagnostic dilemma of central skull base osteomyelitis mimicking neoplasia in a diabetic patient. BMJ Case Rep. 2013, 2013
                                                                                      6. Spielmann PM et al: Skull base osteomyelitis: current microbiology and management. J Laryngol Otol. 127 Suppl 1:S8-12, 2013
                                                                                      7. Adams A et al: Central skull base osteomyelitis as a complication of necrotizing otitis externa: Imaging findings, complications, and challenges of diagnosis. Clin Radiol. 67(10):e7-e16, 2012
                                                                                      8. Blyth CC et al: Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 17(2):306-11, 2011
                                                                                      9. Ozgen B et al: Diffusion MR imaging features of skull base osteomyelitis compared with skull base malignancy. AJNR Am J Neuroradiol. 32(1):179-84, 2011
                                                                                      10. Borges A: Imaging of the central skull base. Neuroimaging Clin N Am. 19(4):669-96, 2009
                                                                                      11. Clark MP et al: Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base. 19(4):247-54, 2009
                                                                                      12. Lin YJ et al: Posterior fossa intracranial inflammatory pseudotumor: a case report and literature review. Surg Neurol. 72(6):712-6; discussion 716, 2009
                                                                                      13. Carfrae MJ et al: Malignant otitis externa. Otolaryngol Clin North Am. 41(3):537-49, viii-ix, 2008
                                                                                      14. Bouccara D et al: [Osteomyelitis of the skull base due to otologic or sinus infections. 5 cases.] Ann Otolaryngol Chir Cervicofac. 124(1):25-32, 2007
                                                                                      15. Lee EJ et al: MR imaging of orbital inflammatory pseudotumors with extraorbital extension. Korean J Radiol. 6(2):82-8, 2005
                                                                                      16. Singh A et al: Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg. 133(1):121-5, 2005
                                                                                      17. Chang PC et al: Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol. 24(7):1310-6, 2003
                                                                                      18. Chan LL et al: Imaging of mucormycosis skull base osteomyelitis. AJNR Am J Neuroradiol. 21(5): 828-31, 2000
                                                                                      19. Slattery WH 3rd et al: Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am. 29(5):795-806, 1996
                                                                                      20. Anielski R et al: [Surgical treatment of goiter in older people.] Wiad Lek. 42(10):633-5, 1989