Fig. 11

Osteomyelitis of the skull base. A 74-year-old man presenting with slowly progressive symptoms of left hypoglossal nerve palsy and left VCP. CT and MR images at the level of the skull base (not displayed) showed fluid in the mastoid and middle ear bilaterally. a Contrast-enhanced CT and b) T1-weighted contrast-enhanced images with fat saturation showed infiltration of the area between the petrous apex and the temporo-mandibular joint by a destructive enhancing mass (*). The imaging findings suggested osteomyelitis and soft tissue infection. The jugular foramen and thereby the vagal nerve were obviously involved, causing VCP. The patient underwent left-sided exploration and mastoidectomy revealing massive infection of the middle ear, skull-base and neck