Intra-arterial administration of antibiotics for refractory skull base osteomyelitis
Intra-arterial administration of antibiotics for refractory skull base osteomyelitis
复制标题
动脉内注射抗生素治疗难治性颅底骨髓炎
DOI：
10.1016/j.anl.2013.12.003
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发表时间：
2014
影响因子：
1.7
通讯作者：
Tona R
中科院分区：
文献类型：
--
作者：
Yamazaki H;Kikuchi M;Shinohara S;Naito Y;Fujiwara K;Kanazawa Y;Tona R
我们报告了两例老年糖尿病男性患有源自恶性外耳炎（MEO）的颅底骨髓炎（SBO）的病例。在这两种情况下，常规治疗（包括长期静脉注射培养导向抗生素、严格控制血糖水平以及手术清创感染性肉芽组织）后，破坏性感染和神经麻痹恶化。由于病灶内抗生素灌注不良可能与MEO/SBO的严重性质有关，我们通过逆行导管在动脉内注射抗生素，尖端设置在颈外动脉近端，以增加上颌动脉（MA）和咽升动脉（APA）供应区的组织药物浓度，在这些区域观察到强烈的炎症。这种动脉内给予抗生素（IA疗法）以及长期静脉内和口服抗生素治疗消除了他们的感染，并且在2年的随访期内没有观察到复发。有趣的是，通过导管进行血管造影的 CT 图像显示，与 APA 供应区域相比，MA 供应区域的增强更强，并且前者的 IA 治疗更有效。这些结果表明，IA 疗法可能在感染部位达到高抗生素浓度，对于传统治疗难治的 MEO/SBO 患者有效。
We report two cases of elderly diabetic men with skull base osteomyelitis (SBO) originating from malignant external otitis (MEO). In both, a devastating infection and neural paralysis deteriorated after conventional therapy, including long-term intravenous administration of culture-directed antibiotics with strict control of blood sugar levels and surgical debridement of infectious granulation tissue. Since poor perfusion of antibiotics in the lesion may be associated with serious nature of MEO/SBO, we administered antibiotics intra-arterially via a retrograde catheter with the tip set at the proximal point of the external carotid artery to increase the tissue drug concentration in the maxillary artery (MA) and ascending pharyngeal artery (APA) supply areas, in which intense inflammation was observed. This intra-arterial administration of antibiotics (IA therapy) followed by long-term intravenous and oral antibiotic treatments eliminated their infection and no recurrence was observed in 2 years follow-up period. Interestingly, CT images of angiography via the catheter demonstrated stronger enhancement in the MA supply area compared to the APA supply area and IA therapy was more effective in the former. These results suggest that IA therapy, which might achieve high antibiotic concentration at the site of infection, is effective in patients with MEO/SBO refractory to conventional treatments.