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S080: SINGLE-ARM META-ANALYSIS OF COMBINED MEDICAL-SURGICAL MANAGEMENT OUTCOMES IN LATERAL SKULL BASE OSTEOMYELITIS
Khushal Gupta, MBBS¹; Michael Karsy, MD, PhD, MSc, FAANS, FCNS²; ¹Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; ²University of Michigan Health

Introduction: Lateral skull base osteomyelitis (LSBO) is a rare but devastating infection that often resists medical therapy alone and can threaten both life and function. In recent years, surgical approaches have been added to antibiotic regimens in an attempt to improve outcomes, yet reported results vary widely across small, single-center series. To bring clarity to this field, we performed a systematic review and single-arm meta-analysis of combined medical–surgical management in LSBO, focusing on disease control, survival, and treatment-related morbidity.

Methods: We systematically searched PubMed, Scopus, Embase, and Web of Science through May 2025, following PRISMA guidelines. Eligible studies included ≥5 patients with LSBO who underwent combined medical and surgical therapy. Case reports, purely medical cohorts, and narrative reviews were excluded. Two independent reviewers extracted study characteristics and outcomes into a structured template. The primary outcomes were surgical intervention rate and disease control/cure. Secondary outcomes included overall mortality, disease-specific mortality, and hospitalization duration. Proportions were pooled using random-effects models (DerSimonian–Laird) with Freeman–Tukey double arcsine transformation, while continuous data were pooled as weighted means. Heterogeneity was quantified using I², τ², and Cochran’s Q, and prediction intervals were calculated to assess the range of likely future results.

Results: A total of 11 studies including 1,186 patients met criteria. The pooled surgical intervention rate was 33% (95% CI: 23–43%; prediction interval: 5–69%). In the subset of four studies (n=126) that specifically reported disease control or cure, the pooled rate was 65% (95% CI: 47–82%). Across ten studies (n=1,157), the pooled overall mortality was 16% (95% CI: 2–37%), though heterogeneity was high and likely reflects differences in baseline comorbidities, disease severity, and reporting practices. Disease-related mortality was lower, at 4% (95% CI: 1–9%). Across four studies (n=879), the mean hospital stay was 24 days (95% CI: 15–33), reflecting the prolonged recovery course.

Conclusion: Our analysis shows that surgical intervention remains necessary for roughly one-third of patients with LSBO, and when combined with medical therapy, results in disease control for nearly two-thirds. Disease-specific mortality is relatively low, but overall mortality and extended hospitalizations emphasize the seriousness of this condition. Considerable variability across studies underscores the urgent need for standardized definitions, prospective registries, and multicenter collaboration. This study provides the most comprehensive quantitative synthesis of LSBO outcomes to date and reinforces the role of surgery as an important adjunct to antibiotics in select patients. High heterogeneity across outcomes highlights differences in patient selection, treatment thresholds, and institutional practices, underscoring the need for standardized protocols and prospective multicenter data.

 

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