Antibiotic Management of Pseudotumors of the Skull Base

Introduction: Pseudotumors are inflammatory non-neoplastic disorders that rarely occur in the skull base but can be extremely aggressive and mimic malignancy. Chronic infection has been postulated as a cause. Diagnostic biopsies are difficult to achieve, given the anatomical considerations, so treatment is often initiated based on clinical suspicion. Current treatment options based on single case reports or series include radiotherapy, systemic steroids, and surgery alone or in combination; however, they are controversial and well known to have potentially life-threatening risks and side effects.

Objective: To review the use of antibiotics in the management options of skull base pseudotumors.

Design: Retrospective review of cases and literature.

Methods: Literature searches on PubMed, EMBASE, Cochrane, and NHS evidence databases, as well as cases from our institution.

Results: There is limited literature on management of skull base pseudotumors. A case report by T. Hokazu et al showed that antibiotics with steroids reduced the size of an inflammatory pseudotumor of the maxillary sinus, but there are no studies on antibiotic use alone. In our institution, we had two cases of pseudotumors of the skull base. Biopsies were taken for histology and microbiology. One species grew sensitive to ciprofloxacin, and long-term treatment was initiated without the use of steroids. Both cases showed clinical and radiological improvement.

Conclusion: Pseudotumor of the skull base is a challenging condition to diagnose and treat. Long-term low-dose antibiotic treatment alone is an alternative option with relatively low risks of morbidity and mortality.