Skull Base Osteomyelitis (SBO)

Skull base osteomyelitis is a rare life-threatening condition, often misdiagnosed for malignancy seen most commonly in immunocompromised patients, generally caused by ear or sinus infections. Atypical skull base osteomyelitis commonly involves sphenoid and occipital bones. SBO can occur in elderly patients with diabetes mellitus or immunosuppression, and there are many predisposing factors.

It was found that with early and aggressive culture guided long-term intravenous broad-spectrum antibiotic therapy decreases post-infection complications. In cases of widespread soft tissue involvement, an early aggressive surgical removal of infectious sequestra with preferentially Hyperbaric Oxygen (HBO) therapy is associated with better prognosis of disease, less neurologic sequelae and mortality rate. Complete resolution of the SBO cases may take several months

Skull base osteomyelitis (SBO) is an infection of the temporal, sphenoid, or occipital bones that is typically caused by a complication of improperly treated otogenic or sinonasal infection in elderly patients with diabetes or immunocompromised patients. Generally, it presents with headaches, low grade fever and multiple cranial nerve weakness.

It is difficult to treat. The mainstay treatment for SBO includes a course of  long-term intravenous broad-spectrum antibiotic therapy.  In cases of widespread soft-tissue involvement, early aggressive surgical removal of infectious sequestra is required.

PET CT showing infective process (reddish)
Bone destruction