Objectives To perform a systematic review examining experiences with endoscopic resection of skull base lesions in the pediatric population, with a focus on outcomes, recurrence, and surgical morbidities. Methods PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases were evaluated. Studies were assessed for level of evidence. Bias risk was evaluated using the Cochrane Bias tool, Grades of Recommendation, Assessment, Development and Evaluation (GRADE), and Methodological Index for Non-Randomized Studies (MINORS) criteria. Patient characteristics, pathology, site of primary disease, presenting symptoms, stage, procedure specific details, and complications were evaluated. Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines. Results Ninety-three studies met criteria for inclusion, encompassing 574 patients with skull base tumors. The GRADE and MINORS criteria determined the overall evidence to be moderate quality. The most common benign and malignant pathologies included juvenile nasopharyngeal angiofibromas (n = 239) and chondrosarcomas (n = 11) at 41.6 and 1.9%, respectively. Of all juvenile nasopharyngeal angiofibroma tumors, most presented at stage IIIa and IIIb (25.8 and 27.3%, respectively). Nasal obstruction (16.5%) and headache (16.0%) were common symptoms at initial presentation. Surgical approaches included endoscopic endonasal (n = 193, 41.2%) and endoscopic extended transsphenoidal (n = 155, 33.1%). Early (< 6 weeks) and late (>6 weeks) complications included cerebrospinal fluid leak (n = 36, 17.3%) and endocrinopathy (n = 43, 20.7%). Mean follow-up time was 37 months (0.5–180 months), with 86.5% showing no evidence of disease and 2.1% having died from disease at last follow-up. Conclusion Endoscopic skull base surgery has been shown to be a safe and effective method of treating a variety of pediatric skull base tumors. If appropriately employed, the minimally invasive approach can provide optimal results in the pediatric population.

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.

Many FDA-approved anti-cancer therapies, targeted toward a wide array of molecular targets and signaling networks, have been demonstrated to activate the unfolded protein response (UPR). Despite a critical role for UPR signaling in the apoptotic execution of cancer cells by many of these compounds, the authors are currently unaware of any instance whereby a cancer drug was developed with the UPR as the intended target. With the essential role of the UPR as a driving force in the genesis and maintenance of the malignant phenotype, a great number of pre-clinical studies have surged into the medical literature describing the ability of dozens of compounds to induce UPR signaling in a myriad of cancer models. The focus of the current work is to review the literature and explore the role of the UPR as a mediator of chemotherapy-induced cell death in squamous cell Carcinomas of the head and neck (HNSCC) and oral cavity (OCSCC), with an emphasis on preclinical studies.

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