3350. Skull Base Osteomyelitis: A Dreaded Clinical Entity
Authors* Denotes Presenting Author
Fatima Mubarak *;
Aga Khan University Hospital
Objective:
The objective of this study is to review the presenting features, comorbidities, microbiology, radiological findings, treatment entities, complications and outcomes in skull base osteomyelitis (SBO).
Materials and Methods:
We conducted a retrospective study of adult patients who were admitted or visited the outpatient department with skull-based osteomyelitis at the hospital between July 2013 and October 2020. We included all adult patients (= 18 years old) who had clinical and radiological diagnosis of SBO either on CT scan or MRI (head and brain). A detailed chart review was carried out of all adult patients with SBO to collect data by using a structured proforma. Patient demographic details, clinical characteristics, comorbidities, laboratory and radiological investigation, treatment, complications and outcomes were recorded.
Results:
Fifty-six patients were included in the study with mean age was 58.12 (± 17.79) years and there was male predominance (69.6%). Diabetes Mellitus (DM)was the most common comorbid illness (69.6 %). Most patients had chronic sinusitis, otitis media, or and head and neck surgery in the last 2 years. The mean duration between onset of symptoms and presentation to healthcare facilities was 12 weeks (± 13.96). The common symptoms were headache (68%), facial asymmetry (41.1 %), fever (39.3 %), altered mental status (32%), earache (30.4 %) and hearing loss (30.4 %). Most patients had fungal organisms isolated from tissue culture, i.e. Aspergillus flavus, penecillium, Rhizopus spp, or Absidia spp. Cranial nerve (CN) paresis was present in 77 % of patients with predominance of 7th CN (55.4 %). Other complications were meningitis (55.4 %), ischemic stroke (46.4 % ), sepsis (32.1) and cerebral venous sinus thrombosis (25 %). The overall mortality was 32.2 %. Complications in nonsurvivor group were sepsis, stroke, and meningitis, but only the presence of sepsis was found to be associated with mortality (<em>p</em> < 0.001).
Conclusion:
SBO is rare disease that is associated with serious morbidity and mortality. Cranial nerve neuropathy, sepsis, CVST, ischemic arterial stroke, and meningitis were common complications of SBO. Early recognition and appropriate management of this treatable, but life-threatening, condition are crucial to improve outcomes.
