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Updated: Jun 10, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Presentation and Optimal Management of Anterior and Central Skull Base Osteoradionecrosis: Systematic Review and
Sunny R Shah1,2, Arthur Wu3, Raj Sindwani4
1Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Objective:
To conduct a systematic review and meta-analysis to compare the efficacy of conservative treatment versus surgical debridement versus debridement followed by vascularized tissue coverage to provide evidence-based guidance on the management of osteoradionecrosis of the anterior and central skull base.
Data Sources:
PubMed, Embase, and Cochrane Library.
Review Methods:
Systematic review and data sources including PubMed, Embase, and Cochrane Library were accessed using PRISMA guidelines. Meta-analysis was performed on treatment type and resolution of osteoradionecrosis.
Results:
A total of 13 articles met the inclusion criteria. Patients were categorized into conservative medical treatment versus surgical treatment. Conservative treatment included patients undergoing hyperbaric oxygen therapy, antibiotics, pentoxifylline-tocopherol-clodronate, or a combination of the three. Eight out of 197 patients treated with conservative therapy had resolution of symptoms (4.1%) while 135 of 188 patients treated with surgical intervention had resolution of symptoms (71.8%). Of these, 104 patients (91.2%) in the vascularized tissue group experienced resolution of symptoms.
Conclusion:
Surgery was superior to medical treatment alone in the resolution of skull base osteoradionecrosis. Vascularized surgical treatment fared significantly better when compared with both surgical debridement only and/or medical treatment. Our findings suggest that surgical treatment should be considered earlier in patients with skull base osteoradionecrosis to prevent severe or fatal sequelae.
Level Of Evidence:
NA Laryngoscope, 135:982-990, 2025.
