Treatment Outcomes for Osteoradionecrosis of the Central Skull Base: A Systematic Review

Abstract

Objective Osteoradionecrosis (ORN) of the skull base can have catastrophic consequences if not detected early and managed appropriately. This is a systematic review of the different treatment modalities for skull base ORN and their outcomes. Study Design This study is a systematic review. Materials and Methods Two researchers extracted information including patient population, surgical technique, outcomes of interest, and study design. A computerized search of Medline, Embase, and the Cochrane library (January 1990–June 2020) looked for several papers on the subject of skull base ORN. Results A total of 29 studies had met inclusion criteria, including data from 333 patients. Nasopharyngeal carcinoma was the most common primary tumor (85%). Average age at diagnosis of ORN was 55.9 years (range = 15–80 years) and 72.3% of patients were males. The average time to diagnosis of ORN after radiation therapy was 77 months with an average radiation dose of 76.2 Gy (range = 46–202 Gy). Nighty-eight patients (29.4%) also had chemotherapy as part of their treatment regimen. Although all parts of the central skull base were reported to be involved, the clivus and sphenoid bone were the most commonly reported subsites. Trial of medical treatment had a success rate of 41.1%. About 66% of patients needed surgical treatment, either primarily or after failing medical treatment. Success rate was 77.3%. Overall, the surgical treatment was superior to medical treatment (p < 0.0001). Conclusion ORN is a rare complication of the treatment of skull base tumors. Most cases require surgical treatment, including endoscopic debridement or free flap reconstruction, which has a high success rate. Level of Evidence Level 3 evidence as a systematic review of case studies, case reports, retrospective, and prospective trials with no blinding or controls.

Anterior Skull Base Osteoradionecrosis in the Age of Intensity-Modulated Radiation Therapy: A Case Series

“…sequestrectomy, soft tissue debridement, fistula closure, and flap reconstruction (both local and free flaps) 2,14 .…”

“…In one patient, this approach plus cauterization resulted in disease control while the other needed surgical debridement followed by a local flap along with IV antibiotics to achieve adequate control. In a systematic review, Shaikh et al analyzed the different treatment options for skull base ORN, finding that 82.6% of patients underwent medical treatment first 14 . Medical treatment options consist of antibiotics, HBO therapy, and pentoxifylline with tocopherol.…”

“…surgical management where Shaikh and colleagues found that debridement with free flap reconstruction is significantly superior to endoscopic debridement alone or endoscopic debridement with a local flap 14 . Additional studies also endorse the use of microvascular free flap reconstruction in extensive ORN 2,10,[21][22][23] .…”

“…ORN most likely develops because XRT causes hypocellularity, hypovascularity, and abnormal osteoblast and osteoclast activity, leading to ischemic necrosis [8][9][10] . In Otolaryngology, the most common ORN site is the mandible;however, ORN has also occurred in the anterior, central, and lateral skull base 1,[5][6][7][11][12][13][14] .…”

“…Timely diagnosis and treatment of skull base ORN can prevent complications such as internal carotid artery bleeding, meningitis, cerebrospinal fluid leaks, pathologic fractures, and more 2,6,15,16 . Treatment strategies include antibiotics, hyperbaric oxygen (HBO), pentoxifylline and tocopherol, and surgical intervention 14 . Surgical treatments commonly include This article is protected by copyright.…”