Management of the Osteoradionecrosis of the Median Skull Base: Systematic Review

Objectives: Osteoradionecrosis (ORN) of the skull base can potentially lead to 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 outcome.

Study Design: systematic review.

Methods: Two researchers extracted information involving 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 management of skull base ORN.

Results: A total of 29 studies met inclusion criteria. A total of 333 patients were pooled. Nasopharyngeal carcinoma was the most common primary tumor (85%). Average age at occurrence of ORN was 55.9 years (15–80 years. The average duration of ORN occurrence after radiation therapy was 77 months. 72.3% were male. Average dose of radiation therapy was 76.2 Gy (range of 46–20). 98 patients (29.4%) had also chemotherapy as part of their treatment regimen. Although all parts of the median skull base were reported to be involved, clivus and sphenoid bone were the most commonly involved. The majority of ORN patients (202 patients, 62.5%) needed surgical treatment, including endoscopic debridement (92 patients, 28.5%) and free flap reconstruction (89 patients, 28.1%). Success rate of surgical treatment to clear or keep ORN under control was 98.8% with a mortality rate of 1.2%. Average follow-up after ORN treatment was 29 months.

Conclusion: ORN is a rare complication of the treatment of skull base tumors. Most of the cases require surgical treatment, mostly endoscopic debridement or free flap reconstruction, with very high success rate.

Publication History

Article published online:
12 February 2021