Skull base osteoradionecrosis: from pathogenesis to treatment

Area of Science:

• Oncology
• Radiotherapy
• Head and Neck Surgery

Background:

• Skull base osteoradionecrosis (ORN) is a rare but severe complication following radiotherapy for head and neck cancers.
• It arises from radiation-induced tissue damage, leading to hypovascularity, hypoxia, and necrosis, often complicated by infection.

Purpose of the Study:

• To comprehensively review skull base osteoradionecrosis (ORN).
• To analyze its pathogenesis, clinical presentation, diagnostic strategies, and management.
• To emphasize the critical role of multidisciplinary care in addressing ORN.

Main Methods:

• Literature review of pathogenesis, clinical presentation, diagnostics, and management of skull base ORN.
• Analysis of recent advances in radiotherapy techniques and emerging treatments.
• Evaluation of surgical interventions and multimodal imaging utility.

Main Results:

• Radiotherapy advances have decreased ORN incidence, but it persists, especially with high-dose fields.
• Hyperbaric oxygen and pentoxifylline-tocopherol show promise but lack standardized evidence.
• Vascularized tissue reconstruction offers favorable outcomes for refractory ORN.
• Multimodal imaging (MRI, PET/CT) aids in differentiating ORN from tumor recurrence.

Conclusions:

• Skull base ORN is a complex, potentially life-threatening condition requiring tailored, multidisciplinary management.
• Diagnostic and therapeutic advancements have improved outcomes, yet standardized protocols are lacking.
• Further research is essential to refine treatment strategies and enhance evidence-based practices for ORN.