Management of osteomyelitis of the anterior skull base and craniovertebral junction.

OBJECTIVES The study goals were to determine the patient demographics, identify predisposing factors, and determine efficacy of treatment for nonotologic osteomyelitis of the skull base and craniovertebral junction. STUDY DESIGN All patients with a biopsy-proven diagnosis of osteomyelitis of the skull base treated by the author from 1997 through 2001 were retrospectively evaluated. RESULTS Six patients were identified on review. The average age at presentation was 56.7 years (age range, 38 to 70 years), and all except one patient had an underlying immunocompromising condition (diabetes mellitus, human immunodeficiency virus infection, steroid use). Most presented with neurologic deficits associated with a destructive lesion of the osseous skull base. Aggressive debridement of involved bone enabled through the use of broad field standard skull base approaches was associated with clinical resolution of symptoms in each case. Systemic antibacterial/antifungal therapy and medical optimization remain important adjuncts in the treatment of this group of patients. CONCLUSION The diagnosis of this entity may be difficult to discern from neoplastic involvement of the skull base. Standard skull base approaches are useful for both the diagnosis and the treatment of nonotologic osteomyelitis.