Features and Management of Osteoradionecrosis of the Skull Base A Systematic Review and Meta-Analysis.

[BACKGROUND] Skull base osteoradionecrosis (SBORN) is a rare but potentially devastating consequence of radiotherapy (RT) for head and neck tumors. This study aims to synthesize existing literature and analyze treatment outcomes among patients with SBORN.

[METHODS] A systematic literature search was conducted following PRISMA guidelines. Adult patients with SBORN were included. Random effects modeling was used for meta-analysis.

[RESULTS] Overall, 29 studies with 593 patients were included. Mean time to presentation of SBORN following RT was 84.3 months. Analysis of treatment modalities revealed 165 patients underwent conservative management, 258 surgery without free flap reconstruction, and 101 surgery with free flap reconstruction. Meta-analysis demonstrated a significantly lower death rate in patients who underwent free tissue transfer, compared to those who were managed conservatively (p < 0.01).

[CONCLUSIONS] SBORN represents a challenging complication following radiotherapy of head and neck tumors. The consequences can be catastrophic; therefore, prompt identification and treatment are key. The use of vascularized free tissue transfer for patients with significant structural defects from SBORN may improve survivorship compared to conservative treatment measures; however, further research on treatment outcomes is warranted.