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Acta Neurochir (Wien). 2019 Jan 3. doi: 10.1007/s00701-018-3768-5. [Epub ahead of print]

Nocardial clival osteomyelitis secondary to sphenoid sinusitis: an atypical skull base infection.

Author information

1
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA.
2
Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, 11030, USA.
3
Department of Neurosurgery, Carolinas Medical Center, Charlotte, NC, 28203, USA.
4
Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
5
Mayfield Clinic, Cincinnati, OH, 45209, USA.
6
Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
7
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA. neuropub@hsc.utah.edu.

Abstract

Clival osteomyelitis is a life-threatening complication of untreated malignant otitis externa or paranasal sinus infection. Although various pathogens have been implicated, to our knowledge, primary nocardial clival osteomyelitis has never been reported. We describe a 74-year-old woman who presented with headaches, abducens and hypoglossal nerve palsies, facial numbness, photophobia, and neck stiffness. Imaging revealed a heterogeneous mass within the sphenoid sinus with clival extension. The lesion was extirpated via a binostril endoscopic endonasal transsphenoidal approach. Histopathological and microbiological examination revealed a nocardial source. Clival osteomyelitis associated with sphenoid sinusitis should be included in the differential diagnosis of progressive skull base lesions in the setting of an underlying infection. Early recognition and intervention with antibiotics and surgical debridement is essential in the management of this rare entity.

KEYWORDS:

Clivus; Infection; Nocardia; Osteomyelitis; Sinusitis; Skull base; Sphenoid sinus

PMID:
30607637
DOI:
10.1007/s00701-018-3768-5

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