Abstract
Objectives
Based on current evidence, this systematic review focuses on various gray areas related
to these patients' diagnosis, management, and follow-up in central skull base osteomyelitis
(CSBO).
Study Design
A systematic review of all case reports and observational studies.
Methods
We systematically searched PubMed, Scopus database, Cochrane database, U.K. clinicaltrails.gov
registry, and World Health Organization International Clinical Trials Registry Platform
and included all reports as per our inclusion criteria. Data was analyzed systematically,
and we made essential observations.
Results
Out of 179 articles, 25 were selected according to inclusion criteria and quality
assessment. Among the 44 patients, refractory headache (95%) was the most common presentation,
followed by cranial nerve paralysis (82%) and Pseudomonas (32%) as the most common
bacteria. Contrary to the available literature the disease cure was worse in those
who underwent targeted biopsy (64% vs. 36%, p = 0.023) and surgical debridement (61% vs. 39%, p = 0.013) in the late stages of the disease.
Conclusion
Otogenic osteomyelitis can spread to central skull bones in the absence of obvious
ear symptoms. Early diagnosis and intervention of CSBO before progression to late
stages can help decrease significant morbidity and mortality.
Keywords
atypical skull base osteomyelitis - central skull base osteomyelitis - clival osteomyelitis
- petrous apicitis
