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

被引:7
作者
Abou-Al-Shaar, Hussam [1 ,2 ]
Mulvaney, Graham G. [3 ]
Alzhrani, Gmaan [1 ,4 ]
Gozal, Yair M. [1 ,5 ]
Oakley, Gretchen M. [6 ]
Couldwell, William T. [1 ]
机构
[1] Univ Utah, Clin Neurosci Ctr, Dept Neurosurg, 175 North Med Dr East, Salt Lake City, UT 84132 USA
[2] Hofstra Northwell Sch Med, Dept Neurosurg, Manhasset, NY 11030 USA
[3] Carolinas Med Ctr, Dept Neurosurg, Charlotte, NC 28203 USA
[4] King Fahad Med City, Natl Neurosci Inst, Dept Neurosurg, Riyadh, Saudi Arabia
[5] Mayfield Clin, Cincinnati, OH 45209 USA
[6] Univ Utah, Div Otolaryngol Head & Neck Surg, Salt Lake City, UT USA
关键词
Osteomyelitis; Skull base; Clivus; Sphenoid sinus; Sinusitis; Nocardia; Infection; ASTEROIDES; PACHYMENINGITIS; DIAGNOSIS; OTITIS; SYSTEM;
D O I
10.1007/s00701-018-3768-5
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:529 / 534
页数:6
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