Acta Neurochirurgica

, Volume 161, Issue 3, pp 529–534 | Cite as

Nocardial clival osteomyelitis secondary to sphenoid sinusitis: an atypical skull base infection

  • Hussam Abou-Al-Shaar
  • Graham G. Mulvaney
  • Gmaan Alzhrani
  • Yair M. Gozal
  • Gretchen M. Oakley
  • William T. CouldwellEmail author
Case Report - Infection
Part of the following topical collections:
  1. Infection


Clival osteomyelitis is a life-threatening complication of untreated malignant otitis externa or paranasal sinus infection. Although various pathogens have been implicated, to our knowledge, primary nocardial clival osteomyelitis has never been reported. We describe a 74-year-old woman who presented with headaches, abducens and hypoglossal nerve palsies, facial numbness, photophobia, and neck stiffness. Imaging revealed a heterogeneous mass within the sphenoid sinus with clival extension. The lesion was extirpated via a binostril endoscopic endonasal transsphenoidal approach. Histopathological and microbiological examination revealed a nocardial source. Clival osteomyelitis associated with sphenoid sinusitis should be included in the differential diagnosis of progressive skull base lesions in the setting of an underlying infection. Early recognition and intervention with antibiotics and surgical debridement is essential in the management of this rare entity.


Osteomyelitis Skull base Clivus Sphenoid sinus Sinusitis Nocardia Infection 



We thank Kristin Kraus, MSc, our medical editor, for her contribution to manuscript editing.

Compliance with ethical standards

Patient consent

The patient has consented to the submission of the case report for submission to the journal.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Hussam Abou-Al-Shaar
    • 1
    • 2
  • Graham G. Mulvaney
    • 3
  • Gmaan Alzhrani
    • 1
    • 4
  • Yair M. Gozal
    • 1
    • 5
  • Gretchen M. Oakley
    • 6
  • William T. Couldwell
    • 1
    Email author
  1. 1.Department of Neurosurgery, Clinical Neurosciences CenterUniversity of UtahSalt Lake CityUSA
  2. 2.Department of NeurosurgeryHofstra Northwell School of MedicineManhassetUSA
  3. 3.Department of NeurosurgeryCarolinas Medical CenterCharlotteUSA
  4. 4.Department of Neurosurgery, National Neuroscience InstituteKing Fahad Medical CityRiyadhSaudi Arabia
  5. 5.Mayfield ClinicCincinnatiUSA
  6. 6.Division of Otolaryngology-Head and Neck SurgeryUniversity of UtahSalt Lake CityUSA

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