Osteomyelitis is an acute or chronic inflammation of the bone and bone marrow, usually caused by a bacterial infection.
Osteomyelitis of the Skull
The skull is typically very resistant to osteomyelitis; hematogenous infections are rare. Osteomyelitis of the skull usually occurs due to infections of nearby structures such as sinusitis or a scalp abscess[^1] or penetrating trauma[^1].
In prolonged infections of the skull, they can become visible through swelling and edema and are then referred to as a Pott puffy tumor[^1].
Pathogens
Staphylococcus is the most common pathogen, with Staphylococcus aureus being the most frequent causative agent, followed by Staphylococcus epidermidis[^1].
Imaging
In imaging, osteomyelitis often shows bone resorption, periosteal reaction, and contrast enhancement[^1].
Treatment
Treatment with antibiotics alone is rarely curative. Treatment typically involves surgical debridement of the infection with removal of the damaged bone. In the case of osteomyelitis in the area of the bone flap of a craniotomy, it should be removed and the bone edges trimmed with a rongeur to healthy bone[^1].
Following surgical therapy, an antibiotic therapy of 6 to 12 weeks should ensue[^2]. The antibiotic therapy should be pathogen-specific and can be initiated with vancomycin and cefepime or meropenem[^1]. Most treatment failures occur in patients who received antibiotics for less than 4 weeks postoperatively[1].