Saxena Alisha, Paul Birinder Singh, Singh Gagandeep, Ahluwalia Archana, Paul Gunchan
Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.
Department of Radiodiagnosis, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.
J Neurosci Rural Pract. 2021 Sep 28;12(4):751-757. doi: 10.1055/s-0041-1735324. eCollection 2021 Oct.
Skull base osteomyelitis (SBO) is an enigmatic clinical diagnosis which is difficult to decipher and is associated with poor outcomes. The study aims to examine the demographic and clinical characteristics of patients with SBO and its outcomes. Medical records of 30 patients with diagnosis of SBO over past 5 years were assessed for demographic and clinical characteristics, type of SBO, radiological parameters, treatment received, procedure performed, microbiological profile, comorbidities, and complications including cranial nerve (CN) palsies. These factors were analyzed for prediction of outcome (death or survival). Microsoft Office Excel 2010 SAS 10.0 for Windows was used. Student's -test for continuous variables (age, duration of symptoms, number of days of hospitalization, and treatment duration) and chi-square test for categorical variables (imaging findings, symptomatology, presence of comorbidities, surgical procedure, complications, and type of antibiotics) were utilized. We found SBO was the disease of elderly population (64.07 ± 6.13 years) with male predominance (83.3%) highly associated with uncontrolled diabetes status (93.3%). Headache (100%) and CN palsy (80%) were the most common neurological presenting complaints followed by stroke (17%) and encephalopathy (10%). Pathological and radiological correlation showed that fungal infection ( ) was associated with anterior SBO (10%), while bacteria ( ) was cultured from posterior SBO (30%). Fifty per cent of patients were alive after 1 year out of which 33% had good functional outcome. The mortality rate was 33.3% in our cohort and multiple lower CN palsies ( = 0.04), suboptimal duration of medical treatment ( = 0.03), surgical intervention during clinical course ( = 0.02), and development of intracranial or extracranial complications ( = 0.03) were the predictors of mortality. Early diagnosis including identification of pathogenic organisms and optimal duration of treatment are crucial factors for improved outcomes in SBO.
颅底骨髓炎（SBO）是一种难以诊断的临床病症，且预后较差。本研究旨在探讨SBO患者的人口统计学和临床特征及其预后情况。对过去5年中30例诊断为SBO的患者的病历进行评估，内容包括人口统计学和临床特征、SBO类型、放射学参数、接受的治疗、实施的手术、微生物学特征、合并症以及包括脑神经（CN）麻痹在内的并发症。分析这些因素以预测预后（死亡或存活）。使用了适用于Windows的Microsoft Office Excel 2010和SAS 10.0。对连续变量（年龄、症状持续时间、住院天数和治疗持续时间）采用Student's t检验，对分类变量（影像学表现、症状、合并症的存在、手术操作、并发症和抗生素类型）采用卡方检验。我们发现SBO是老年人群的疾病（64.07±6.13岁），男性占主导（83.3%），与未控制的糖尿病状态高度相关（93.3%）。头痛（100%）和CN麻痹（80%）是最常见的神经系统主诉，其次是中风（17%）和脑病（10%）。病理与放射学相关性显示，真菌感染（ ）与前部SBO相关（10%），而后部SBO培养出细菌（ ）（30%）。1年后50%的患者存活，其中33%功能预后良好。我们队列中的死亡率为33.3%，多发性下CN麻痹（ =0.04）、药物治疗持续时间不理想（ =0.03）、临床过程中的手术干预（ =0.02）以及颅内或颅外并发症的发生（ =0.03）是死亡的预测因素。早期诊断，包括病原体的鉴定和最佳治疗持续时间，是改善SBO预后的关键因素。
