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. 2009 Jul;19(4):247-54.
doi: 10.1055/s-0028-1115325.

Central or Atypical Skull Base Osteomyelitis: Diagnosis and Treatment

Free PMC article

Central or Atypical Skull Base Osteomyelitis: Diagnosis and Treatment

Matthew P A Clark et al. Skull Base. .
Free PMC article


Objective: We report cases of central or atypical skull base osteomyelitis and review issues related to the diagnosis and treatment.

Methods: The four cases presented, which were drawn from the Oxford, United Kingdom, skull base pathology database, had a diagnosis of central skull base osteomyelitis.

Results: Four cases are presented in which central skull base osteomyelitis was diagnosed. Contrary to malignant otitis externa, our cases were not preceded by immediate external infections and had normal external ear examinations. They presented with headache and a variety of cranial neuropathies. Imaging demonstrated bone destruction, and subsequent microbiological analysis diagnosed infection and prompted prolonged antibiotic treatment.

Conclusion: We concluded that in the diabetic or immunocompromised patient, a scenario of headache, cranial neuropathy, and bony destruction on imaging should raise the possibility of skull base osteomyelitis, even in the absence of an obvious infective source. The primary goal should still be to exclude an underlying malignant cause.

Keywords: Skull base; cranial neuropathies; osteomyelitis; otitis externa.


Figure 1
Figure 1
Contrast-enhanced computed tomography (CT) of the skull base (A) shows erosion of the anterior cortex of the left occipital condyle (arrowheads) as well as anterior displacement of the left internal carotid artery (small arrow). The right internal jugular vein is normal (large arrow), whereas the left internal jugular vein is completely occluded. Gadolinium-enhanced magnetic resonance imaging (MRI) of the skull base (B) shows pathological contrast enhancement in the clivus extending into the soft tissues surrounding the left internal carotid artery (arrow) and jugular foramen (black arrowhead). There is thickening and enhancement of the clival dura (white arrowheads).

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