Treatment of a clivus abscess in a child using image-guidance

Osteomyelitis and abscess of the clivus are rare conditions thought to arise from contiguous spread of infection from the paranasal sinuses [D.L. Hoistad, A.J. Duvall III. Sinusitis with contiguous abscess involvement of the clivus and petrous apices. Case report, Ann. Otol. Rhinol. Laryngol. 108 (1999) 463-466] or the temporal bone and petrous apex [S.A. Aziz, P.B. Fayad, F. Fulbright, M.L. Giroux, S.G. Waxman. Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies, Clin. Neurol. Neurosurg. 97 (1995) 239-244], but have also been found to occur with no known source [R. Rusconi, S. Bergamaschi, A. Cazzabillan, V. Carnelli. Clivus osteomyelitis secondary to Enterococcus faecium infection in a 6-year-old girl, Int. J. Ped. Otorhinolaryng. 69 (2005) 1265-1268]. This report represents the second case of a clivus abscess in a child and demonstrates an innovative approach to surgical localization and treatment of abscesses in this area and also potentially in the nearby retropharyngeal region.