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Review
. 2024 Apr 30;86(3):360-369.
doi: 10.1055/a-2297-9474. eCollection 2025 Jun.

Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

Lokesh Kumar P  1 , Garima Upreti  2 , Sabarisan Paramasivam  1 , Sivaraman Ganesan  1 , Arun Alexander  1 , Regi Thomas  3
Affiliations
Review

Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

Lokesh Kumar P et al. J Neurol Surg B Skull Base. .

Abstract

Objectives: Based on current evidence, this systematic review focuses on various gray areas related to these patients' diagnosis, management, and follow-up in central skull base osteomyelitis (CSBO).

Study design: A systematic review of all case reports and observational studies.

Methods: We systematically searched PubMed, Scopus database, Cochrane database, U.K. clinicaltrails.gov registry, and World Health Organization International Clinical Trials Registry Platform and included all reports as per our inclusion criteria. Data was analyzed systematically, and we made essential observations.

Results: Out of 179 articles, 25 were selected according to inclusion criteria and quality assessment. Among the 44 patients, refractory headache (95%) was the most common presentation, followed by cranial nerve paralysis (82%) and Pseudomonas (32%) as the most common bacteria. Contrary to the available literature the disease cure was worse in those who underwent targeted biopsy (64% vs. 36%, p = 0.023) and surgical debridement (61% vs. 39%, p = 0.013) in the late stages of the disease.

Conclusion: Otogenic osteomyelitis can spread to central skull bones in the absence of obvious ear symptoms. Early diagnosis and intervention of CSBO before progression to late stages can help decrease significant morbidity and mortality.

Keywords: atypical skull base osteomyelitis; central skull base osteomyelitis; clival osteomyelitis; petrous apicitis.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Chart 1
Chart 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart depicting the systematic review's stepwise selection of the included articles.
Chart 2
Chart 2
Critical appraisal score for all included studies using Joanna Briggs Institute (JBI) critical appraisal tool. Appraisal scores > 60% - low risk, 30–60% - moderate risk, < 30% - high risk of bias. Studies with low risk of bias were considered for final analysis.
Fig. 1
Fig. 1
Pictorial representation of the skull base subsites involved in different groups of central skull base osteomyelitis (CSBO). ( A ) Group 1 (blue line: area commonly involved in group 1); ( B ) group 2 (red line: area widely involved in group 2); ( C ) group 3 (green shade representing the prevertebral abscess prevalent in group 3); ( D ) group 4 (bilateral skull base involvement).
See this image and copyright information in PMC

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