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J Neurol Surg B Skull Base
DOI: 10.1055/a-2297-9474
Review Article

Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

Lokesh Kumar P. 
1   Department of Ear, Nose, and Throat (ENT), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
,
Garima Upreti 
2   Department of Ear, Nose, and Throat (ENT), All India Institute of Medical Sciences (AIIMS), Rajkot, Rajkot, Gujarat, India
,
Sabarisan Paramasivam 
1   Department of Ear, Nose, and Throat (ENT), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
,
Sivaraman Ganesan
1   Department of Ear, Nose, and Throat (ENT), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
,
Arun Alexander 
1   Department of Ear, Nose, and Throat (ENT), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
,
Regi Thomas 
3   Department of Ear, Nose, and Throat (ENT), Christian Medical College Hospital, Vellore, Tamil Nadu, India
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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

Authors' Contributions

L.K.P.: Data extraction, quality analysis, data interpretation, and manuscript writing.


G.U.: Data extraction, quality analysis, and manuscript writing.


S.P.: Data extraction, quality check, and data interpretation.


S.G.: Manuscript correction and statistical analysis.


A.A.: Manuscript correction, statistical analysis, and peer review.


R.T.: Manuscript correction, statistical analysis, and peer review.


Supplementary Material



Publication History

Received: 16 January 2024

Accepted: 31 March 2024

Accepted Manuscript online:
02 April 2024

Article published online:
30 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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