Skull osteomyelitis treatment

• Novel application of chelator-based bone debridement for refractory skull osteonecrosis complicated by Pseudomonas aeruginosa osteomyelitis
• Calvarial Syphilitic Osteomyelitis as a Rare Manifestation of Secondary Syphilis in an Immunocompetent Patient: A Rare Diagnostic Challenge
• Skull Base Osteomyelitis- Microbiological Profile and Management Implications
• Refining necrotising otitis externa management: A follow-up study on a departmental algorithm and the role of nuclear medicine imaging
• Clival Osteomyelitis Secondary to Isolated Sphenoid Sinusitis Caused by Nocardia veterana in an Immunocompetent Patient: A Case Report
• A pathogen-detection's odyssey in a case of skull base osteomyelitis: Land ahoy!
• Langerhans cell histiocytosis of the jaw: clinical analysis of 68 cases
• Potential of zoledronate for treating diffuse sclerosing osteomyelitis of the mandible in adult patients

Early identification of the causative pathogen, appropriate broad-spectrum antibiotic therapy over a period of 8-20 weeks, and aggressive surgical debridement are essential for managing cranial osteomyelitis. On the other hand, inadequate treatment is responsible for refractory cases and poses a great diagnostic challenge. A new classification dividing cranial osteomyelitis into sinorhino-otogenic versus nonsinorhino-otogenic groups could prove valuable for clinical communication and treatment ¹⁾.

Antibiotics for skull osteomyelitis alone are rarely curative.

• Novel application of chelator-based bone debridement for refractory skull osteonecrosis complicated by Pseudomonas aeruginosa osteomyelitis
• Skull Base Osteomyelitis- Microbiological Profile and Management Implications
• A pathogen-detection's odyssey in a case of skull base osteomyelitis: Land ahoy!
• Langerhans cell histiocytosis of the jaw: clinical analysis of 68 cases
• Potential of zoledronate for treating diffuse sclerosing osteomyelitis of the mandible in adult patients
• Pre-treatment and post-treatment nasopharyngeal carcinoma imaging: imaging updates, pearls and pitfalls
• Skull Base Rhabdomyosarcoma Mimicking Osteomyelitis in a Pediatric Patient
• Defining the Appropriate Length of Antimicrobial Therapy for Skull Base Osteomyelitis

Treatment usually involves surgical debridement of the infected skull, biting off the infected bone with rongeurs until a normal snapping sound replaces the more muted sound made by rongeuring infected bone. In the case of an infected craniotomy bone flap, the flap usually must be removed and discarded, and the edges of the skull rongeured back to healthy bone. Bone suspected of infection should be sent for cultures.

Closure of the scalp is then performed either leaving a bone defect (for later cranioplasty) or cranioplasty can be performed using titanium mesh.

Debridement surgery is followed by at least 6–12 weeks of antibiotics ²⁾.

Until MRSA is ruled out: vancomycin + cefepime or meropenem. Culture results guide the choice of antibiotic. Once MRSA is ruled out, vancomycin may be changed to penicillinase-resistant synthetic penicillin (e.g. nafcillin). Most treatment failures occurred in patients treated with < 4 weeks of antibiotics following surgery.

Cranioplasty may be performed ≈ 6 months post-op if there are no signs of residual infection.