중심형 두개저 골수염의 임상 경과
Central Skull Base Osteomyelitis: 10-Case Series in a Single Center
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Background and Objectives Skull base osteomyelitis (SBO) typically evolves as a complication of malignant otitis externa (MOE) in diabetic patients and involves the temporal bone. Central SBO (CSBO), which mainly involves the sphenoid or occipital bones, has clinical and radiological characteristics similar to those of SBO but without coexisting MOE. We investigated a group of patients with CSBO and studied the clinical course of CSBO. Subjects and Method Medical records of patients who were diagnosed with CSBO were retrospectively analyzed from 1999 to 2014. Results Ten patients (mean age; 60.5 years) were identified. There were five males and five females. All patients suffered from headache, and six patients had cranial nerve palsy including oculomotor (20%), abducens (10%), vestibulocochlear (10%), glossopharyngeal (20%), vagus (30%) and hypoglossal (10%) nerve. Patients had underlying diseases including diabetes mellitus (40%), immunosuppression status after liver transplantation (10%) and cardiovascular disease (40%). Four patients received endoscopic biopsy and debridement for diagnostic and curative intent. Patients were treated with intravenous antibiotics for 5.1 weeks in average and oral antibiotics for 17 weeks. Mean follow-up period was 12.4 months and the mortality rate was zero. 40% of patients had residual neurologic deficit. The earliest sign of improving CSBO was headache (mean; 3.1 weeks) and the erythrocyte sedimentation rate was the latest improving sign (mean; 4 months). Conclusion CSBO was diagnostic and therapeutic challenge to the clinicians. The timely diagnosis and long-term antibiotics therapy could avoid a mortality case and minimize the permanent neurologic deficit. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(3):207-13
Abstract
Background and Objectives Skull base osteomyelitis (SBO) typically evolves as a complication of malignant otitis externa (MOE) in diabetic patients and involves the temporal bone. Central SBO (CSBO), which mainly involves the sphenoid or occipital bones, has clinical and radiological characteristics similar to those of SBO but without coexisting MOE. We investigated a group of patients with CSBO and studied the clinical course of CSBO. Subjects and Method Medical records of patients who were diagnosed with CSBO were retrospectively analyzed from 1999 to 2014. Results Ten patients (mean age; 60.5 years) were identified. There were five males and five females. All patients suffered from headache, and six patients had cranial nerve palsy including oculomotor (20%), abducens (10%), vestibulocochlear (10%), glossopharyngeal (20%), vagus (30%) and hypoglossal (10%) nerve. Patients had underlying diseases including diabetes mellitus (40%), immunosuppression status after liver transplantation (10%) and cardiovascular disease (40%). Four patients received endoscopic biopsy and debridement for diagnostic and curative intent. Patients were treated with intravenous antibiotics for 5.1 weeks in average and oral antibiotics for 17 weeks. Mean follow-up period was 12.4 months and the mortality rate was zero. 40% of patients had residual neurologic deficit. The earliest sign of improving CSBO was headache (mean; 3.1 weeks) and the erythrocyte sedimentation rate was the latest improving sign (mean; 4 months). Conclusion CSBO was diagnostic and therapeutic challenge to the clinicians. The timely diagnosis and long-term antibiotics therapy could avoid a mortality case and minimize the permanent neurologic deficit. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(3):207-13
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