What Is Craniotabes?

Osteomyelitis of skull is a non-specific inflammatory reaction caused by pathogens invading the skull. It is more common in adolescents and often has a history of head trauma. It is mostly caused by contaminated head wounds or the spread of infections in the vicinity of the head A small number are caused by the spread of blood.

Basic Information

English name

Skull Osteomyelitis

Visiting department

neurosurgery

Multiple groups

teens

Common locations

skull

Common causes

Caused by contaminated head wounds or the spread of infections near the head

Common symptoms

Local redness, swelling and pain; fluctuations under the scalp, drainage of pus, or spontaneous rupture to discharge pus; repeated attacks, unhealed

Causes of skull osteomyelitis

1. Traumatic or post-operative wound infection caused by pathogenic bacteria directly invading the skull, or exposure to the skull due to radiation therapy or scalp avulsion. More than 80% of the pathogenic bacteria of osteomyelitis after craniotomy and trauma are Staphylococcus aureus. Others include Escherichia coli, Proteus, Klebsiella and Enterobacter.

2. Infection can directly invade the skull with paranasal sinusitis, mastoiditis, otitis media, or prolonged scalp infections. The cause of paranasal sinusitis is Staphylococcus aureus. Otogenic infections are often caused by Pseudomonas aeruginosa, especially in diabetes or the elderly.

3. Infection can also be caused by blood-borne infections caused by bacteremia, immune dysfunction, and diseases with reduced anti-infective capacity such as diabetes.

4. The pathogenic bacteria also include the filamentous fungi.

Clinical manifestations of skull osteomyelitis

1. There are few acute inflammation manifestations, localized chronic lesions are common, some may have chronic wound sinuses, and skull base osteomyelitis may also have symptoms and signs of affected cerebral palsy.

2. The early symptoms of acute patients are not obvious. When superficial infection spreads to the deep layer, inflammatory reactions such as local redness, swelling and heat pain occur, and subcutaneous scalp fluctuations gradually occur, drainage of pus, or spontaneous rupture and discharge of pus. It does not heal, and even dead bone is discharged; most patients have no fever, and infections after craniotomy usually occur 1 to 2 weeks after surgery.

Skull osteomyelitis

Blood routine

The total number of white blood cells increased in the acute phase, the proportion of neutrophils increased, and the C-reactive protein increased. The chronic phase was mostly normal.

2. X-ray of skull

There is no abnormality in the early stage. Generally, the bone light transmittance of the lesion area can increase within 2 to 3 weeks after infection, and the range gradually expands, forming bone destruction with irregular edges and uneven density. The lesions can be fused, and dead bones can appear in the damage area. Large density, generally without periosteum and new bone; chronic phase showed significant osteogenesis, local sclerosis and thickening.

3.CT

Can understand the scope of osteomyelitis and the presence of intracranial structure involvement.

4.MRI (magnetic resonance imaging)

The high signal of normal bone marrow on T ₁ WI becomes the same signal as that of brain tissue, which can diagnose osteomyelitis.

5.SPECT (single photon emission [type] computed tomography)

Te-MDP (radioactive nuclide 99m -methylene diphosphate) has local hyperperfusion of osteomyelitis within 24 hours of osteomyelitis; 67 gallium is more sensitive to active lesions and more accurate in diagnosis of cranial osteomyelitis .

Skull osteomyelitis diagnosis

Diagnosis can be made based on the patient's symptoms and signs, especially the redness, swelling, heat, pain and suppuration of the local wound. Plain radiographs and other neuroimaging examinations can confirm the diagnosis of cranial osteomyelitis.

Differential diagnosis of skull osteomyelitis

Xanthomas

The skull showed map-shaped bone destruction, sharp edges, and rarely sclerosis.

2. Skull tumor invasion or metastasis

Most were bone destruction, without necrotic bone and pus cavity.

3. Skull tuberculosis

Bone destruction has sharp edges, less sclerosis, and fewer dead bones.

Skull osteomyelitis treatment

1. Thorough debridement and removal of dead bone, combined with antibiotics that are sensitive to bacteria is currently the most effective treatment method. Acute osteomyelitis requires more full-time, anti-inflammatory treatment at the foot. Systemic antibiotics are used for at least 6 weeks, and oral administration is 8 weeks Above, especially the chronic osteomyelitis of the skull base.

2. The treatment effect is generally judged based on the improvement of the patient's symptoms and signs, the return to normal levels of erythrocyte sedimentation, and the return of normal gallium scans to normal.

Skull osteomyelitis prevention

1. Early cure of primary infections such as paranasal sinusitis and middle ear mastoiditis.

2. Head contaminated wounds should be debrided as soon as possible. Routine surgery should shorten the interval between shaving and surgery. The dura mater should be sutured closely to avoid cerebrospinal fluid leakage. The preventive use of antibiotics should not be performed 2 hours before the incision.