Central Skull Base Osteomyelitis

Authors: A. Mifková 1;  V. Živicová 1;  M. Chovanec 2;  J. Kluh 1;  J. Lisý 3;  J. Plzák 1;  Z. Fík 1;  J. Bouček 1
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku, 1. lékařská fakulta, Univerzita Karlova, Fakultní nemocnice v Motole, Praha 1;  Otorinolaryngologická klinika, 3. lékařská fakulta, Univerzita Karlova, Fakultní nemocnice Královské Vinohrady, Praha 2;  Klinika zobrazovacích metod, 2. lékařská fakulta, Univerzita Karlova, Fakultní nemocnice v Motole, Praha 3
Published in: Otorinolaryng. a Foniat. /Prague/, 67, 2018, No. 1, pp. 32-35.
Category: Case Reports


Central skull base osteomyelitis is a very rare, life threatening disease. There are only few reported cases in the literature. The disease is generally associated with infections of the petrous bone, less often with sinonasal inflammation. It presents a diagnostic and therapeutic challenge with varied symptomatology and differential diagnosis. There was one patient treated for the proven central skull base osteomyelitis during the year 2015 at the Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol. The inflammatory process followed chronic mesotitis with mastoiditis which required surgical intervention. Clinically the disease presented with bilateral hypoglossal palsy and single-sided vagal palsy. Diagnosis has been confirmed by MRI and scintigraphy with labeled leukocytes. Complete remission with the restoration of the cranial nerves function has been achieved due to the long-term antimicrobial therapy (10 weeks) against cultivated Pseudomonas aeruginosa. Despite our success in the treatment, central skull base osteomyelitis is a serious disease with significant mortality even if treated properly.

skull base osteomyelitis, otitis media, cranial nerve palsy, scintigraphy, Pseudomonas aeruginosa


1. Azizi, S. A., Fayad, P. B., Fulbright, R. et al.: Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies. Clin. Neurol. Neurosurg., 97, 1995, 3, s. 239-244.

2. Bar-Shalom, R., Yefremov, N., Guralnik, L. et al.: SPECT/CT using 67Ga and 111In-labeled leukocyte scintigraphy for diagnosis of infection. J. Nucl. Med., 47, 2006, 4, s. 587-594.

3. Boucek, J., Staffhorst, B., Grotenhuis, A. et al.: Neuroaspergillosis following postoperative radiotherapy for temporal bone squamous cell carcinoma. Journal of International Advanced Otology, 9, 2013, 2, s. 273-278.

4. Clark, M. P., Pretorius, P. M., Byren, I. et al.: Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base, 19, 2009, 4, s. 247-254.

5. Conde-Diaz, C., Llenas-Garcia, J., Parra Grande, M. et al.: Severe skull base osteomyelitis caused by Pseudomonas aeruginosa with successful outcome after prolonged outpatient therapy with continuous infusion of ceftazidime and oral ciprofloxacin: A case report. J. Med. Case Rep., 11, 2017, 1, s. 48.

6. Damle, N. A., Patwardhan, V. V., Arora, A.: Incremental value of SPECT/CT over planar bone scan in the evaluation of skull base osteomyelitis: A potentially fatal disease in diabetics. Indian J. Endocrinol. Metab., 17, 2013, 6, s. 1128-1129.

7. Debnam, J. M.: Imaging of the head and neck following radiation treatment. Patolog. Res. Int., 2011, s. 607-820.

8. Ducic, Y.: Skull base osteomyelitis. South Med. J., 99, 2006, 10, s. 1051.

9. Gold, S., Som, P. M., Lucente, F. E. et al.: Radiographic findings in progressive necrotizing „malignant“ external otitis. Laryngoscope, 94, 1984, 3, s. 363-366.

10. Grobman, L. R., Ganz, W., Casiano, R. et al.: Atypical osteomyelitis of the skull base. Laryngoscope, 99, 1989, 7 Pt 1, s. 671-676.

11. Hoistad, D. L., Duvall, A. J.: Sinusitis with contiguous abscess involvement of the clivus and petrous apices. Case report. Ann. Otol. Rhinol. Laryngál., 108, 1999, 5, s. 463-466.

12. Huang, K. L., Lu, C. S.: Skull base osteomyelitis presenting as Villaret‘s syndrome. Acta Neuro. Taiwan, 15, 2006, 4, s. 255-258.

13. Chakraborty, D., Bhattacharya, A., Gupta, A. K. 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, 2013, 2, s. 65-69.

14. Chang, P. C., Fischbein, N. J., Holliday, R. A.: Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am. J. Neuroradiol., 24, 2003, 7, s. 1310-1316.

15. Johnson, A. K., Batra, P. S.: Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope, 124, 2014, 5, s. 1083-1087.

16. Kreicher, K. L., Hatch, J. L., Lohia, S. et al.: Propionibacterium skull base osteomyelitis complicated by internal carotid artery pseudoaneurysm. Laryngoscope, 2016.

17. Lesser, F. D., Derbyshire, S. G., Lewis-Jones, H.: Can computed tomography and magnetic resonance imaging differentiate between malignant pathology and osteomyelitis in the central skull base? J. Laryngál. Otol., 129, 2015, 9, s. 852-859.

18. Nanni, C., Fanti, S., PET-CT: Rare findings and diseases. Springer, Berlin, Heidelberg, 2012.

19. Orioli, L., Boute, C., Eloy, P. et al.: Central skull base osteomyelitis: a rare but life-threatening disease. Acta Clin. Belg., 70, 2015, 4, s. 291-294.

20. Osei-Yeboah, C., Neequaye, J., Bulley, H. et al.: Osteomyelitis of the frontal bone. Ghana Med. J., 41, 2007, 2, s. 88-90.

21. Ridder, G. J., Breunig, C., Kaminsky, J. et al.: Central skull base osteomyelitis: new insights and implications for diagnosis and treatment. Eur. Arch. Otorhinolaryngol., 272, 2015, 5, s. 1269-1276.

22. Soga, Y., Oka, K., Sato, M. et al.: Cavernous sinus thrombophlebitis caused by sphenoid sinusitis--Report of autopsy case. Clin. Neuropathol., 20, 2001, 3, s. 101-105.

23. Stodulski, D., Teodorczyk, J., Kowalska, B. et al.: The usefulness of bone scannning for the diagnosis and evaluation of otogenic skull base osteomyelitis. A description of three cases. Nucl. Med. Rev. Cent. Eas.t Eur., 8, 2005, 1, s. 33-36.

24. Taranath, A., Prelog, K.: Sella turcica collection due to skull base osteomyelitis. Pediatr. Radiol., 35, 2005, 4, s. 451.

Audiology Paediatric ENT ENT (Otorhinolaryngology)
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account