Diagnose einer Osteomyelitis der Schädelbasis

Die Diagnose einer Schädelbasisosteomyelitis wird oft verzögert gestellt, da mehrere Krankheiten sie in der Bildgebung imitieren und sie als maligne Erkrankung fehlgedeutet werden kann. In dieser Übersichtsarbeit beschreiben die Autoren die Anatomie der Schädelbasis sowie Symptome, Ursachen, Infektionswege, Komplikationen, Differenzialdiagnosen und Behandlung der Erkrankung. Die bildgebenden Befunde werden anhand von 6 Fallbeispielen erläutert.

Abstract

Skull base osteomyelitis (SBO) is an infection of the temporal, sphenoid, or occipital bone that can be a challenge to diagnose because of its nonspecific symptoms, long clinical course, and radiologic findings that mimic those of other entities. The authors review this unusual infection on the basis of six proven cases. The diagnosis of SBO should be made according to four points: a high index of clinical suspicion, radiologic evidence of infection, repeated biopsies that are negative for malignancy, and positive results of microbiologic tests. SBO typically manifests clinically in patients with diabetes and recurrent otitis externa; the infection usually extends inferiorly to the compact bone of the infratemporal fossa, affecting the lower cranial nerve foramina. Several image-based techniques should be used to diagnose SBO. CT is the best option for evaluating bone erosion and demineralization, MRI can help delineate the anatomic location and extent of disease, and nuclear imaging is useful for confirming bone infection with high sensitivity. However, the standard diagnostic procedure for SBO is for patients to undergo repeated biopsies to rule out malignancy, with histopathologic signs of infection and detection of microorganisms in the biopsied bone or soft tissue indicating SBO. The ability to diagnose SBO can be increased by identifying patients at risk, recognizing the most important causes and routes of infection, describing the main radiologic findings, and always considering the differential diagnosis.

Kernaussagen

• Die Schädelbasisosteomyelitis ist eine Infektion des Schläfen-, Keil- oder Hinterhauptbeins, die typischerweise als Komplikation einer unsachgemäß behandelten otogenen oder sinunasalen Infektion bei älteren Erkrankten mit Diabetes oder immungeschwächten Personen auftritt.

• Sie hat häufig einen otogenen Ursprung, typischerweise bei mit Diabetes Erkrankten und rezidivierender Otitis externa. Andere Ursachen für Schädelbasisosteomyelitis sind die eitrige Otitis media und die Mastoiditis.

• Pseudomonas aeruginosa ist der am häufigsten vorkommende bakterielle Erreger, gefolgt von Staphylococcus aureus. Es besteht allgemeines Einvernehmen darüber, dass es sich bei den am häufigsten vorkommenden Pilzerregern um Aspergillusspezies handelt, obwohl dies von der jeweiligen Studie abhängt.

• Die Diagnose der Schädelbasisosteomyelitis wird in der Regel erst spät gestellt. Sie sollte sich auf 4 Säulen stützen: einen hohen klinischen Verdachtsindex, einen radiologischen Nachweis der Infektion, wiederholte Biopsieergebnisse, die negativ für Malignität sind, und eine positive mikrobiologische Isolierung.

• Bei der Differenzialdiagnose der Schädelbasisosteomyelitis ist das Nasopharynxkarzinom die wichtigste Diagnose. Da die Bildgebung keine Unterscheidung zwischen Schädelbasisosteomyelitis und Nasopharynxkarzinom zulässt, ist eine Biopsie erforderlich.

Schlüsselwörter

Osteomyelitis - Schädelbasis - Bildgebung

Keywords

skull base - osteomyelitis - image-based techniques

Publication History

Article published online:
02 August 2022

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