Endoscopic surgery and temporalis muscle flap reconstruction for skull base osteoradionecrosis after radiotherapy

Skull base osteoradionecrosis (sbORN) is a serious late complication of radiotherapy for nasopharyngeal carcinoma (NPC), with limited effective treatment options. In this retrospective cohort study, we aimed to compare the outcomes and treatment efficacy between patients with sbORN who did and those who did not undergo endoscopic extended resection with temporalis muscle flap reconstruction.

The study involved 57 patients (24 female and 33 male patients; age range: 41-78 years) diagnosed with sbORN following radiotherapy for NPC between September 2019 and September 2022 at our hospital, followed up until April 2025. The surgical group (n = 30) underwent extended endoscopic resection of necrotic skull base lesions with temporalis muscle flap reconstruction, whereas the non-surgical group (n = 27) received conservative management. Therapeutic interventions, demographic characteristics, survival, and symptomatic/quality-of-life profiles were evaluated.

In the surgical group, the mean pain and foul odor scores decreased significantly over 12 months, and the quality-of-life scores improved substantially over 12 months. The surgical group had a significantly longer median survival time and a higher 24-month overall survival rate than the non-surgical group did. Furthermore, multivariable analysis confirmed surgical intervention as an independent favorable prognostic factor for survival, which was associated with a reduced incidence of severe complications such as carotid blowout syndrome.

Endoscopic extended resection with temporalis muscle flap reconstruction appears to be a safe, effective, and feasible treatment for sbORN following radiotherapy for NPC.