Clinical Features and Surgical Outcomes in Patients With Central Skull Base Osteomyelitis

OBJECTIVES: Central skull base osteomyelitis (CSBO) is a rare but potentially life-threatening condition primarily involving the sphenoid or occipital bones, with reported mortality rates of 30% to 50%. Owing to its low incidence, evidence-based diagnostic and treatment guidelines remain limited. This study aimed to characterize the clinical features, microbiologic spectrum, and treatment outcomes of patients with CSBO. STUDY DESIGN: Retrospective cohort study. SETTING: Single tertiary referral center. METHODS: This study included 22 patients diagnosed with CSBO between November 2013 and December 2022. Clinical data, including presenting symptoms, comorbidities, surgical interventions, microbiologic findings, antimicrobial regimens and duration, hospitalization length, and clinical outcomes, were analyzed. RESULT: Diabetes mellitus was the most common underlying condition (n = 15, 68.2%). The predominant symptoms were headache (n = 14, 63.6%) and otologic complaints (n = 5, 22.7%). Surgical specimen cultures identified bacterial pathogens in 7 patients (32.0%), fungal pathogens in 9 (41.0%), and mixed bacterial-fungal pathogens in 5 (23.0%). Nineteen patients (83.4%) underwent surgical debridement; earlier debridement was correlated with a shorter duration of antimicrobial therapy (R = 0.545, P = .016). Complete remission was achieved in 19 patients (83.4%), and the overall mortality rate was 13.6%. CONCLUSION: Pathogen identification through surgical sampling is crucial for the effective management of CSBO, enabling timely and targeted antimicrobial therapy. Surgical debridement appears to improve clinical outcomes and reduce treatment duration. Prompt diagnosis and early surgical intervention may therefore be essential for achieving a favorable prognosis in patients with CSBO.