How to Cite this Article Spillinger A Park K Shenouda K Folbe AJ Endoscopic management of postradiation skull base osteoradionecrosis Int Forum Allergy Rhinol-Osteoradionecrosis (ORN) of the skull base is a rare but potentially life-threatening complication after radiotherapy in the treatment of nasopharyngeal carcinoma (NPC). It portends a poor prognosis, mainly due to risk of exsanguination from internal carotid artery (ICA) rupture. 1 Limited data exist regarding the use of conservative therapies, such as hyperbaric oxygen, tocopherol, and pentoxifylline, and surgery remains the mainstay treatment. 2,3 Despite the major role of surgery in managing skull base ORN, there exists a paucity of literature regarding experiences with endoscopic endonasal approaches. The objective of this study was to perform a systematic review and metaanalysis to synthesize experiences with endoscopic skull base surgery (ESBS) and determine resolution and complication rates.

There are no curative treatments for cervical dystonia (CD), therefore conventional management is aimed at pain relief and muscle relaxation. Many patients with CD use complementary and integrative medicine interventions to manage symptoms, yet there are limited data on the use of acupuncture for CD. The aim of the current study was to determine the feasibility, safety, and efficacy of adjuvant acupuncture. A pilot open-label study was conducted on acupuncture treatments as add-on therapy to botulinum-toxin injection sessions (3 months apart) in 5 subjects with chronic idiopathic CD. Six 1-hour acupuncture sessions were administered every other week over the 3-month period between consecutive botulinum-toxin sessions. Data from exploratory efficacy endpoints-including a visual analogue scale for pain, the Clinician Global Impression of Change, the Patient Global Impression of Change, the Toronto Western Spasmodic Torticollis Rating Scale, and the Short Form-36) Health Survey-were collected. Five subjects completed the study with only 1 acupuncture session missed by 1 subject, thereby meeting the study's predetermined adherence goal. All participants reported improvement from acupuncture. Only minor adverse events were reported, with self-resolved discomfort in 1 subject and self-resolved minor bruising in 2 subjects. Acupuncture is feasible and safe as an adjunct treatment for chronic CD, and might be associated with subjective symptomatic benefits.

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