[Value of hyperbaric oxygen in the treatment of advanced skull base osteomyelitis]

Abstract

Background: The therapy of skull base osteomyelitis (SBO) is still challenging. Standard therapy includes the use of antibiotics, local treatment and surgical removal of necrotic bone and tissue. This study reports on the value of adjuvant hyperbaric oxygen therapy with respect to the functional outcome in SBO. Furthermore diagnostic signs especially on imaging are elaborated.

Methods: The retrospective study included all cases of SBO treated between July 2002 and November 2006 in our department. Clinical data, microbiology, laboratory and radiological findings were reviewed. Treatment modality data, especially the use of adjuvant hyperbaric oxygen therapy (HBO) were analysed. The outcome with regard to neurological or functional deficit was assessed and the value of adjuvant HBO therapy was evaluated in comparison with the literature.

Results: In the given time period ten patients with SBO could be selected. The presumption diagnosis based on CT and/or MRI in first line. It was confirmed by histology in all cases. Treatment included high dose antibiotics, surgical debridement and adjuvant HBO therapy. Cure rate of treated patients was 8/8, regarding inflammatory signs. Two patients refused any further therapy during the course, in both the outcome was fatal. Functional recovery of cranial nerve deficits could be reached in 6/8. Two patients had residual cranial nerve palsies. The outcome was mainly influenced by the treatment modality and duration of cranial nerve involvement.

Conclusions: Adjuvant hyperbaric oxygen therapy has been proved to be highly effective in the treatment of advanced SBO. Cranial nerve palsies can recover completely under optimized treatment including adjuvant HBO therapy.