Skip to main content
SpringerLink
Log in

Outcomes and Prognoses

  • Chapter
  • First Online:
Cranial Osteomyelitis

  • 473 Accesses

Abstract

The prognosis of cranial osteomyelitis has improved with the advancement of imaging and biologic tools, the development of more potent antimicrobial agents and a refinement of surgical techniques. Overall, it is clear that the severity of infection, the anatomic site of the disease, the coexistence of intracranial extension, the underlying medical condition, and the delay in diagnosis play an important role in the outcomes of cranial bone infections. Nowadays, as seen in our experience and others, excellent prognosis in otherwise uncomplicated cases is possible with the appropriate treatment. However, osteomyelitis of the cranial skeleton still have undoubted potential for permanent nervous system damage or fatal consequences and continue to pose a significant challenge to the contemporary neurosurgeon worldwide. Factors associated with excellent and poor prognosis in cranial osteomyelitis are presented in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CSBO:

Central skull base osteomyelitis

SBO:

Skull base osteomyelitis

References

  1. Wilensky AO. Osteomyelitis of the skull. Arch Surg. 1933;27(1):83–158.

    Article  Google Scholar 

  2. Eisenstein VW, Friedman ED, Davison C. Brain abscess of uncommon origin-relation to osteomyelitis of the skull: a clinicopathologic study. Ann Surg. 1942;115(3):336–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ridder GJ, Breunig C, Kaminsky J, Pfeiffer J. Central skull base osteomyelitis: new insights and implications for diagnosis and treatment. Eur Arch Otorhinolaryngol. 2015;272(5):1269–76. doi:10.1007/s00405-014-3390-y.

    Article  PubMed  Google Scholar 

  4. Johnson AK, Batra PS. Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 2014;124(5):1083–7. doi:10.1002/lary.24440.

    Article  PubMed  Google Scholar 

  5. Parida PK, Surianarayanan G, Ganeshan S, Saxena SK. Pott’s puffy tumor in pediatric age group: a retrospective study. Int J Pediatr Otorhinolaryngol. 2012;76(9):1274–7. doi:10.1016/j.ijporl.2012.05.018.

    Article  PubMed  Google Scholar 

  6. Salomão JF, Cervante TP, Bellas AR, Boechat MC, Pone SM, Pone MV, de A Pereira B. Neurosurgical implications of Pott’s puffy tumor in children and adolescents. Childs Nerv Syst. 2014;30(9):1527–34. doi:10.1007/s00381-014-2480-x.

    Article  PubMed  Google Scholar 

  7. Akiyama K, Karaki M, Mori N. Evaluation of adult Pott’s puffy tumor: our five cases and 27 literature cases. Laryngoscope. 2012;122(11):2382–8. doi:10.1002/lary.23490.

    Article  PubMed  Google Scholar 

  8. Epstein JS, Ganz WI, Lizak M, Grobman L, Goodwin WJ, Dewanjee MK. Indium 111-labeled leukocyte scintigraphy in evaluating head and neck infections. Ann Otol Rhinol Laryngol. 1992;101(12):961–8.

    CAS  PubMed  Google Scholar 

  9. Seabold JE, Simonson TM, Weber PC, Thompson BH, Harris KG, Rezai K, Madsen MT, Hoffman HT. Cranial osteomyelitis: diagnosis and follow-up with In-111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT, and MR imaging. Radiology. 1995;196(3):779–88.

    Article  CAS  PubMed  Google Scholar 

  10. Bhaskar IP, Inglis TJ, Lee GY. Clinical, radiological, and microbiological profile of patients with autogenous cranioplasty infections. World Neurosurg. 2014;82(3–4):e531–4. doi:10.1016/j.wneu.2013.01.013.

    Article  PubMed  Google Scholar 

  11. Blumenkopf B, Hartshorne MF, Bauman JM, Cawthon MA, Patton JA, Friedman AH. Craniotomy flap osteomyelitis: a diagnostic approach. J Neurosurg. 1987;66(1):96–101.

    Article  CAS  PubMed  Google Scholar 

  12. Moser R, Schweintzger G, Uggowitzer M, Urban C, Stammberger H, Eder H, Kerbl R. Recurrent Pott’s puffy tumor—atypical presentation of a rare disorder. Wien Klin Wochenschr. 2009;121(21–22):719–22. doi:10.1007/s00508-009-1268-6.

    Article  PubMed  Google Scholar 

  13. Radosavljević R, Zivković V, Mojsilović Z. [Chronic recurrent Hematogenous osteomyelitis of the skull bones and other sites]. Med Pregl. 1984;37(1–2):47–9. Croatian.

    PubMed  Google Scholar 

  14. Leahy TW, Sader C. A rare case of bilateral malignant otitis externa and osteomyelitis with lower cranial nerve sequelae. BMJ Case Rep. 2011. pii: bcr0320113957. doi: 10.1136/bcr.03.2011.3957.

    Google Scholar 

  15. Lin YT, Chen CT, Lai JP. Post-traumatic fronto-ethmoid osteomyelitis treated with free muscle transfer. J Plast Reconstr Aesthet Surg. 2010;63(6):963–9. doi:10.1016/j.bjps.2009.03.017.

    Article  PubMed  Google Scholar 

  16. Singh A, Al Khabori M, Hyder MJ. Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg. 2005;133:121–5.

    Article  PubMed  Google Scholar 

  17. Limaiem F, Bellil S, Bellil K, Chelly I, Mekni A, Kallel J, Haouet S, Zitouna M, Kchir N. Hydatid cyst of the cranial vault. J Infect Dev Ctries. 2009;3(10):807–10.

    Article  PubMed  Google Scholar 

  18. Kanaka TS, Balasubramaniam V, Meenakshisundaram E, Varadarajan M. Hydatid of the skull. Indian J Surg. 1970;32:200–3.

    Google Scholar 

  19. Yazdani N, Basam A, Heidarali M, Kashani SS, Hasibi M, Mokhtari Z. Infratemporal hydatid cyst: a case presenting with blindness. J Laryngol Otol. 2010;124(4):456–9. doi:10.1017/S0022215109991927.

    Article  CAS  PubMed  Google Scholar 

  20. McGrory JE, Pritchard DJ, Unni KK, Ilstrup D, Rowland CM. Malignant lesions arising in chronic osteomyelitis. Clin Orthop Relat Res. 1999;362:181–9.

    Article  Google Scholar 

  21. Sankaran-Kutty M, Corea JR, Ali MS, Kutty MK. Squamous cell carcinoma in chronic osteomyelitis. Report of a case and review of the literature. Clin Orthop. 1985;198:264–7.

    Google Scholar 

  22. Panteli M, Puttaswamaiah R, Lowenberg DW, Giannoudis PV. Malignant transformation in chronic osteomyelitis: recognition and principles of management. J Am Acad Orthop Surg. 2014;22(9):586–94.

    Article  PubMed  Google Scholar 

  23. Lu Y, Cen Y, Qing Y, Wang H. [Surgical treatment of chronic osteomyelitis of the skull]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011;25(5):558–61. Chinese.

    PubMed  Google Scholar 

  24. Sercarz JA, Wang MB, Calcaterra TC. Skull base malignancy following long-term sinus mucocele and osteomyelitis. Ann Otol Rhinol Laryngol. 1991;100(2):137–41.

    Article  CAS  PubMed  Google Scholar 

  25. Uren RF, Howman-Giles R. Pott’s puffy tumor. Scintigraphic findings. Clin Nucl Med. 1992;17(9):724–7.

    Article  CAS  PubMed  Google Scholar 

  26. Feder Jr HM, Cates KL, Cementina AM. Pott puffy tumor: a serious occult infection. Pediatrics. 1987;79(4):625–9.

    PubMed  Google Scholar 

  27. Bannon PD, McCormack RF. Pott’s puffy tumor and epidural abscess arising from pansinusitis. J Emerg Med. 2011;41(6):616–22. doi:10.1016/j.jemermed.2008.04.050.

    Article  PubMed  Google Scholar 

  28. Kaabia N, Abdelkafi M, Bellara I, Khalifa M, Bahri F, Letaief A. Pott’s puffy tumor. A case report. Med Mal Infect. 2007;37(6):350–3.

    Article  CAS  PubMed  Google Scholar 

  29. Nisa L, Landis BN, Giger R. Orbital involvement in Pott’s puffy tumor: a systematic review of published cases. Am J Rhinol Allergy. 2012;26(2):e63–70. doi:10.2500/ajra.2012.26.3746.

    Article  PubMed  Google Scholar 

  30. Pandey AS, Surana A. Tuberculous osteomyelitis of the bone flap following craniotomy. Indian J Tuberc. 2011;58(3):129–31.

    PubMed  Google Scholar 

  31. Blyth CC, Gomes L, Sorrell TC, da Cruz M, Sud A, Chen SC. Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 2011;17(2):306–11. doi:10.1111/j.1469-0691.2010.03231.x.

    Article  CAS  PubMed  Google Scholar 

  32. Patel B, Souqiyyeh A, Ali A. A case of transient, isolated cranial nerve VI palsy due to skull base osteomyelitis. Case Rep Infect Dis. 2014;2014:369867. doi:10.1155/2014/369867.

    PubMed  PubMed Central  Google Scholar 

  33. Kim CW, Lee JJ, Kim HS, Won JY. Skull base osteomyelitis following a mastoidectomy. Auris Nasus Larynx. 2013;40(6):584–6. doi:10.1016/j.anl.2012.12.002.

    Article  PubMed  Google Scholar 

  34. Chang PC, Fischbein NJ, Holliday RA. Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol. 2003;24(7):1310–6.

    PubMed  Google Scholar 

  35. Ramdurg SR, Gupta DK, Suri A, Sharma BS, Mahapatra AK. Calvarial tuberculosis: uncommon manifestation of common disease—a series of 21 cases. Br J Neurosurg. 2010;24(5):572–7. doi:10.3109/02688697.2010.495166.

    Article  PubMed  Google Scholar 

  36. Ketenci I, Unlü Y, Tucer B, Vural A. The Pott’s puffy tumor: a dangerous sign for intracranial complications. Eur Arch Otorhinolaryngol. 2011;268(12):1755–63. doi:10.1007/s00405-011-1660-5.

    Article  PubMed  Google Scholar 

  37. Tsai BY, Lin KL, Lin TY, Chiu CH, Lee WJ, Hsia SH, Wu CT, Wang HS. Pott’s puffy tumor in children. Childs Nerv Syst. 2010;26(1):53–60. doi:10.1007/s00381-009-0954-z.

    Article  PubMed  Google Scholar 

  38. Panos GZ, Karydis I, Velakoulis SE, Falagas ME. Multi-skeletal Pneumocystis jiroveci (carinii) in an HIV-seropositive patient. Int J STD AIDS. 2007;18(2):134–7.

    Article  PubMed  Google Scholar 

  39. Mazor Y, Sprecher H, Braun E. Mycobacteria kansassi disseminated disease. Isr Med Assoc J. 2010;12(2):121–2.

    PubMed  Google Scholar 

  40. Capdevila O, Zurita A, Domingo E, Corbella X, Alcaide F, Monfort JL, Fernández-Viladrich P. Multiple cranial osteolytic lesions due to Mycobacterium kansasii in a patient with AIDS. Scand J Infect Dis. 1998;30(3):305–6.

    Article  CAS  PubMed  Google Scholar 

  41. Blom NA, Vreede WB. Infected cephalhematomas associated with osteomyelitis, sepsis and meningitis. Pediatr Infect Dis J. 1993;12(12):1015–7.

    Article  CAS  PubMed  Google Scholar 

  42. Abu Hamdeh S, Lytsy B, Ronne-Engström E. Surgical site infections in standard neurosurgery procedures—a study of incidence, impact and potential risk factors. Br J Neurosurg. 2014;28(2):270–5. doi:10.3109/02688697.2013.835376.

    Article  PubMed  Google Scholar 

  43. Nisbet M, Briggs S, Ellis-Pegler R, Thomas M, Holland D. Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection. J Antimicrob Chemother. 2007;60(5):1097–103.

    Article  CAS  PubMed  Google Scholar 

  44. Larsson A, Engström M, Uusijärvi J, Kihlström L, Lind F, Mathiesen T. Hyperbaric oxygen treatment of postoperative neurosurgical infections. Neurosurgery. 2002;50(2):287–95.

    PubMed  Google Scholar 

  45. Olsen JJ, Bingaman KD. Cranial bone flap infections and osteomyelitis of the skull. In: Osenbach RK, Zeidman SM, editors. Infections in neurological surgery diagnosis and management. Philadelphia, PA: Lippincott-Ravan; 1999.

    Google Scholar 

  46. Bruce JN, Bruce SS. Preservation of bone flaps in patients with postcraniotomy infections. J Neurosurg. 2003;98(6):1203–7.

    Article  PubMed  Google Scholar 

  47. Auguste KI, McDermott MW. Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients. J Neurosurg. 2006;105(4):640–4.

    Article  PubMed  Google Scholar 

  48. Delgado-López PD, Martín-Velasco V, Castilla-Díez JM, Galacho-Harriero AM, Rodríguez-Salazar A. Preservation of bone flap after craniotomy infection. Neurocirugia (Astur). 2009;20(2):124–31.

    Article  Google Scholar 

  49. McClelland III S, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007;45(1):55–9.

    Article  PubMed  Google Scholar 

  50. Asimakopoulos P, Supriya M, Kealey S, Vernham GA. A case-based discussion on a patient with non-otogenic fungal skull base osteomyelitis: pitfalls in diagnosis. J Laryngol Otol. 2013;127(8):817–21. doi:10.1017/S002221511300145X.

    Article  CAS  PubMed  Google Scholar 

  51. Unnikrishnan R, Faizal BP, Pillai MGK, Paul G. Villaret’s syndrome—a rare presentation of skull base osteomyelitis. Amrita J Med. 2013;9(2):32–4.

    Google Scholar 

  52. Senegor M, Lewis HP. Salmonella osteomyelitis of the skull base. Surg Neurol. 1991;36(1):37–9.

    Article  CAS  PubMed  Google Scholar 

  53. Ong A, Blyth CC, Bency R, Vicaretti M, Harun A, Meyer W, Shingde M, Gilroy N, Chapman J, Chen SC. Fatal mycotic aneurysms due to Scedosporium and Pseudallescheria infection. J Clin Microbiol. 2011;49(5):2067–71. doi:10.1128/JCM.02615-10.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Chandler JR, Grobman L, Quencer R, Serafini A. Osteomyelitis of the base of the skull. Laryngoscope. 1986;96(3):245–51.

    Article  CAS  PubMed  Google Scholar 

  55. Ducic Y. Skull base osteomyelitis. South Med J. 2006;99(10):1051.

    Article  PubMed  Google Scholar 

  56. Spielmann PM, Yu R, Neeff M. Skull base osteomyelitis: current microbiology and management. J Laryngol Otol. 2013;127 Suppl 1:S8–12. doi:10.1017/S0022215112002356.

    Article  PubMed  Google Scholar 

  57. Rothholtz VS, Lee AD, Shamloo B, Bazargan M, Pan D, Djalilian HR. Skull base osteomyelitis: the effect of comorbid disease on hospitalization. Laryngoscope. 2008;118(11):1917–24. doi:10.1097/MLG.0b013e31817fae0d.

    Article  PubMed  Google Scholar 

  58. Soga Y, Oka K, Sato M, Kabata T, Kawasaki T, Kawano H, Hayano M. Cavernous sinus thrombophlebitis caused by sphenoid sinusitis—report of autopsy case. Clin Neuropathol. 2001;20(3):101–5.

    CAS  PubMed  Google Scholar 

  59. Cohen I. Osteomyelitis of the Skull. Ann Surg. 1933;97(5):733–48.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Reinig JW, Hungerford GD, Mohrmann ME, Vera CL. Case report 268. Diagnosis: cryptococcal osteomyelitis of the calvaria. Skeletal Radiol. 1984;11(3):221–3.

    Article  CAS  PubMed  Google Scholar 

  61. Abril V, Ortega E, Segarra P, Pedro F, Sabater V, Herrera A. Rhinocerebral mucormycosis in a patient with AIDS: a complication of diabetic ketoacidosis following pentamidine therapy. Clin Infect Dis. 1996;23(4):845–6.

    Article  CAS  PubMed  Google Scholar 

  62. Carr MM, Cusimano MD, Muller PJ, Bilbao J. Aspergillosis of the cranial base. Skull Base Surg. 1994;4(3):159–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Menachof MR, Jackler RK. Otogenic skull base osteomyelitis caused by invasive fungal infection. Otolaryngol Head Neck Surg. 1990;102(3):285–9.

    CAS  PubMed  Google Scholar 

  64. Stodulski D, Kowalska B, Stankiewicz C. Otogenic skull base osteomyelitis caused by invasive fungal infection. Case report and literature review. Eur Arch Otorhinolaryngol. 2006;263(12):1070–6.

    Article  PubMed  Google Scholar 

  65. Dawar P, Satyarthee GD, Sharma BS. Total resolution of large scalp swelling due to calvarial tuberculosis with medical management only: case report and review of the literature. Turk Neurosurg. 2015;25(2):313–6. doi:10.5137/1019-5149.JTN.7937-13.1.

    PubMed  Google Scholar 

  66. Park KH, Lee MS, Hong IK, Sung JY, Choi SH, Park SO, Shin MJ, Chung HW, Lee SH. Bone involvement in secondary syphilis: a case report and systematic review of the literature. Sex Transm Dis. 2014;41(9):532–7. doi:10.1097/OLQ.0000000000000164.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery Avicenne Military Hospital of Marrakech, University of Mohammed V in Rabat, Marrakech, Morocco

    Ali Akhaddar

Authors
  1. Ali Akhaddar
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Akhaddar, A. (2016). Outcomes and Prognoses. In: Cranial Osteomyelitis. Springer, Cham. https://doi.org/10.1007/978-3-319-30268-3_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-30268-3_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30266-9

  • Online ISBN: 978-3-319-30268-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation