Targeted skull base biopsies in the management of central skull base osteomyelitis

Central skull base osteomyelitis has an infective pathology located in the deep-seated regions of the skull base, close to critical neurovascular structures. The disease has significant morbidity and mortality risks associated with it especially if early specific management is not initiated. The diagnostic and therapeutic challenges are in identifying the causative organisms and administering specific antimicrobial therapy on a long-term basis. The routine nasopharyngeal mucosal biopsies tend to be non-representative as the foci of infection is deep-seated and the infected bone sample is necessary to diagnose osteomyelitis. The targeted skull base biopsy technique described in this article outlines the principles of wide exposure and early identification of intraoperative landmarks in order to safely take biopsy and cultures from deep-seated regions, located close to the internal carotid artery.