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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
                  • a.k.a. 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

                      • Nuclear Medicine 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. Chapman PR et al: Skull base osteomyelitis: a comprehensive imaging review. AJNR Am J Neuroradiol. 42(3):404-13, 2021
                                              2. Louarn N et al: A rare presentation of skull-base osteomyelitis with neurovascular sheath extension following external otitis resolved by PET/MRI. Eur J Nucl Med Mol Imaging. 45(11):2025, 2018
                                              3. Rozenblum-Beddok L et al: 99mTc-HMPAO-leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis. Laryngoscope Investig Otolaryngol. 3(3):218-224, 2018
                                              4. van Kroonenburgh AMJL et al: Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Curr Radiol Rep. 6(1):3, 2018
                                              5. Harrison L et al: Granulomatosis with polyangiitis affecting the skull base and manifesting as spontaneous skull base osteomyelitis. BMJ Case Rep. 2016, 2016
                                              6. Orioli L et al: Central skull base osteomyelitis: a rare but life-threatening disease. Acta Clin Belg. 70(4):291-4, 2015
                                              7. Johnson AK et al: Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 124(5):1083-7, 2014
                                              8. Bag AK et al: Neuroimaging: intrinsic lesions of the central skull base region. Semin Ultrasound CT MR. 34(5):412-35, 2013
                                              9. Chakraborty D et al: Skull base osteomyelitis in otitis externa: The utility of triphasic and single photon emission computed tomography/computed tomography bone scintigraphy. Indian J Nucl Med. 28(2):65-9, 2013
                                              10. Ganhewa AD et al: A diagnostic dilemma of central skull base osteomyelitis mimicking neoplasia in a diabetic patient. BMJ Case Rep. 2013, 2013
                                              11. Spielmann PM et al: Skull base osteomyelitis: current microbiology and management. J Laryngol Otol. 127 Suppl 1:S8-12, 2013
                                              12. 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
                                              13. Blyth CC et al: Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 17(2):306-11, 2011
                                              14. 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
                                              15. Borges A: Imaging of the central skull base. Neuroimaging Clin N Am. 19(4):669-96, 2009
                                              16. Clark MP et al: Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base. 19(4):247-54, 2009
                                              17. Lin YJ et al: Posterior fossa intracranial inflammatory pseudotumor: a case report and literature review. Surg Neurol. 72(6):712-6; discussion 716, 2009
                                              18. Carfrae MJ et al: Malignant otitis externa. Otolaryngol Clin North Am. 41(3):537-49, viii-ix, 2008
                                              19. 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
                                              20. Lee EJ et al: MR imaging of orbital inflammatory pseudotumors with extraorbital extension. Korean J Radiol. 6(2):82-8, 2005
                                              21. Singh A et al: Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg. 133(1):121-5, 2005
                                              22. Chang PC et al: Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol. 24(7):1310-6, 2003
                                              23. Chan LL et al: Imaging of mucormycosis skull base osteomyelitis. AJNR Am J Neuroradiol. 21(5): 828-31, 2000
                                              24. Slattery WH 3rd et al: Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am. 29(5):795-806, 1996
                                              25. Anielski R et al: [Surgical treatment of goiter in older people.] Wiad Lek. 42(10):633-5, 1989
                                              26. Mendelson DS et al: Malignant external otitis: the role of computed tomography and radionuclides in evaluation. Radiology. 149(3):745-9, 1983
                                              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
                                                              • a.k.a. 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

                                                                  • Nuclear Medicine 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. Chapman PR et al: Skull base osteomyelitis: a comprehensive imaging review. AJNR Am J Neuroradiol. 42(3):404-13, 2021
                                                                                          2. Louarn N et al: A rare presentation of skull-base osteomyelitis with neurovascular sheath extension following external otitis resolved by PET/MRI. Eur J Nucl Med Mol Imaging. 45(11):2025, 2018
                                                                                          3. Rozenblum-Beddok L et al: 99mTc-HMPAO-leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis. Laryngoscope Investig Otolaryngol. 3(3):218-224, 2018
                                                                                          4. van Kroonenburgh AMJL et al: Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Curr Radiol Rep. 6(1):3, 2018
                                                                                          5. Harrison L et al: Granulomatosis with polyangiitis affecting the skull base and manifesting as spontaneous skull base osteomyelitis. BMJ Case Rep. 2016, 2016
                                                                                          6. Orioli L et al: Central skull base osteomyelitis: a rare but life-threatening disease. Acta Clin Belg. 70(4):291-4, 2015
                                                                                          7. Johnson AK et al: Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 124(5):1083-7, 2014
                                                                                          8. Bag AK et al: Neuroimaging: intrinsic lesions of the central skull base region. Semin Ultrasound CT MR. 34(5):412-35, 2013
                                                                                          9. Chakraborty D et al: Skull base osteomyelitis in otitis externa: The utility of triphasic and single photon emission computed tomography/computed tomography bone scintigraphy. Indian J Nucl Med. 28(2):65-9, 2013
                                                                                          10. Ganhewa AD et al: A diagnostic dilemma of central skull base osteomyelitis mimicking neoplasia in a diabetic patient. BMJ Case Rep. 2013, 2013
                                                                                          11. Spielmann PM et al: Skull base osteomyelitis: current microbiology and management. J Laryngol Otol. 127 Suppl 1:S8-12, 2013
                                                                                          12. 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
                                                                                          13. Blyth CC et al: Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 17(2):306-11, 2011
                                                                                          14. 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
                                                                                          15. Borges A: Imaging of the central skull base. Neuroimaging Clin N Am. 19(4):669-96, 2009
                                                                                          16. Clark MP et al: Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base. 19(4):247-54, 2009
                                                                                          17. Lin YJ et al: Posterior fossa intracranial inflammatory pseudotumor: a case report and literature review. Surg Neurol. 72(6):712-6; discussion 716, 2009
                                                                                          18. Carfrae MJ et al: Malignant otitis externa. Otolaryngol Clin North Am. 41(3):537-49, viii-ix, 2008
                                                                                          19. 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
                                                                                          20. Lee EJ et al: MR imaging of orbital inflammatory pseudotumors with extraorbital extension. Korean J Radiol. 6(2):82-8, 2005
                                                                                          21. Singh A et al: Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg. 133(1):121-5, 2005
                                                                                          22. Chang PC et al: Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol. 24(7):1310-6, 2003
                                                                                          23. Chan LL et al: Imaging of mucormycosis skull base osteomyelitis. AJNR Am J Neuroradiol. 21(5): 828-31, 2000
                                                                                          24. Slattery WH 3rd et al: Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am. 29(5):795-806, 1996
                                                                                          25. Anielski R et al: [Surgical treatment of goiter in older people.] Wiad Lek. 42(10):633-5, 1989
                                                                                          26. Mendelson DS et al: Malignant external otitis: the role of computed tomography and radionuclides in evaluation. Radiology. 149(3):745-9, 1983