Dr. Ashfaque A Ansari and Dr. Lovee Gupta
Clival osteomyelitis is a rare and severe infection of the central skull base that presents significant diagnostic and therapeutic challenges due to its proximity to critical neurovascular structures and its often-non-specific clinical presentation. This retrospective pilot study analyzed 14 patients diagnosed with clival osteomyelitis to delineate clinical features, microbiological profiles, radiological findings, treatment modalities, and outcomes. Our findings reveal a high incidence of stroke, with 50% of patients experiencing cerebrovascular events, often attributable to direct infection spread to adjacent neurovascular structures. The predominant pathogen was mucormycosis, affecting 42.9% of cases, followed by bacterial infections such as methicillin-resistant Staphylococcus aureus (MRSA). The primary treatment approach was endonasal endoscopic debridement combined with targeted antimicrobial therapy, achieving a cure rate of 57%. Despite aggressive management, the overall mortality rate was 21%, primarily due to stroke-related complications. These findings highlight the critical importance of early diagnosis, vigilant neurological monitoring, and timely surgical intervention to improve patient outcomes. Further multicenter studies are warranted to establish standardized diagnostic and therapeutic guidelines for this complex condition.
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