Osteoradionecrosis of the Anterior Cranium

Ness, John A.; Chang, Henry S.; Grabowski, Carol M.; Marentette, Lawrence J.

doi:10.1055/s-2008-1058635

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…Another advantage of ERTC‐SD over the transcranial approach may be the absence of frontal osteotomies in patients who received or are candidate for radiotherapy. In fact, the possible occurrence of frontal osteoradionecrosis can lead to grievous scenarios requiring major surgery …”

Section: Discussionmentioning

confidence: 99%

“…In fact, the possible occurrence of frontal osteoradionecrosis can lead to grievous scenarios requiring major surgery. 25,26 Noteworthy, 8/19 (42.1%) patients had a suspected brain infiltration at preoperative MRI that was not confirmed at final pathological examination. Consequently, the ERTC-SD allowed a more precise staging of the disease in patients who could otherwise have been addressed to more invasive procedures (ie, cranioendoscopic or craniofacial resection), nonsurgical treatments, or even palliation.…”

Section: Discussionmentioning

confidence: 99%

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Transnasal endoscopic surgery in selected nasal‐ethmoidal cancer with suspected brain invasion: Indications, technique, and outcomes

et al. 2019

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Background In nasal‐ethmoidal malignancies, brain involvement is associated with dismal prognosis. Method Patients undergoing endoscopic resection with transnasal craniectomy and subpial dissection (ERTC‐SD) for brain‐invading nasal‐ethmoidal cancer between 2008 and 2016 were included. Complications were analyzed in all patients, whereas oncological outcomes only in patients with pathological brain invasion. The prognostic impact of previous treatments, brain edema, and histology was assessed. Hospitalization ratio was calculated. Results Nineteen patients received ERTC‐SD and 11 had pathological‐proven brain invasion. Histologies were 6 olfactory neuroblastomas (ONB), 3 neuroendocrine carcinomas, and 2 intestinal‐type adenocarcinomas. Mean follow‐up was 21.9 months. Three‐year overall, local recurrence‐free, and distance recurrence‐free survivals were 65.5%, 81.8%, and 68.2%, respectively. Overall and distant recurrence‐free survivals were significantly better in patients with ONB (P = 0.032 and P = 0.013, respectively). Hospitalization ratio was 4.1%. Complication rate was 10.5%. Conclusion In selected nasal‐ethmoidal tumors with brain invasion, ERTC‐SD can provide good local control, satisfactory survival, and limited morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transnasal endoscopic surgery in selected nasal‐ethmoidal cancer with suspected brain invasion: Indications, technique, and outcomes

et al. 2019

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“…It is important to bear in mind that the NFO segment is vulnerable to an intraoperative thermal injury during the osteotomy process, as well as to intra-and postoperative ischemic injury. 4,5 When the supporting tissue functions adequately, the NFO segment usually tolerates those hazards well, providing mechanical support and forehead contour delineation. However, when the ASB has been irradiated, or when adjuvant radiotherapy is planned, as well as in revision open surgeries for recurrence of malignancies, the resistance of the NFO segment to ischemic injury is greatly reduced, whereupon it would need to be wrapped by pericranium in an attempt to reduce the risk for ORN.…”

Section: Discussionmentioning

confidence: 99%

“…High risk of NFO osteonecrosis exists in postoperative irradiated patients, usually due to osteoradionecrosis (ORN). 5 Although pericranial wrapping of the NFO segment has greatly reduced the incidence of ORN, 6,7 the consequences are devastating when it does occur (►Fig. 1) and a revision surgery is usually necessary.…”

Section: Introductionmentioning

confidence: 99%

Anterior Median Skull Base Reconstruction Using a Vascularized Free Flap: Rationale, Patient Selection and Outcome

et al. 2019

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Objectives To present our method of median anterior skull base (ASB) reconstruction using a subcranial approach with a free flap in cases of naso-fronto-orbital (NFO) bony segment failure and in patients at high risk for future failure of the bony frontal segment. Design This study presents as a retrospective case series. Setting Tertiary university-affiliated medical center. Participants Adult and pediatric patients who underwent median ASB resection via the subcranial approach with a free flap reconstruction were participated in this study. Main Outcome Measures Pathologic outcome and postoperative quality of life (QoL) as assessed by a validated Hebrew version of the “Anterior Skull Base Quality-of-Life Questionnaire.” Results The departmental database yielded 13 suitable patients aged between 15 and 70 years. The main indication (n = 7) for ASB surgery was osteoradionecrosis (ORN) of the NFO bony segment which was first detected at an average of 3.6 years (range: 2–32 years) postradiation therapy. High-risk patients for future ORN of the NFO segment (n = 3) were primarily reconstructed using a vascularized free flap. Nine patients had malignant disease, and four of them were alive without evidence of disease during the follow-up period (average, 48 months). Their QoL was comparable to that of patients who had undergone subcranial ASB resection without free flap reconstruction. Conclusions The ASB median free flap method of reconstruction is a safe and reliable in cases of large complex median ASB defects without orbital resection or maxillectomy. This approach is suitable for patients who had undergone previous surgery, radiotherapy and/or those who present with osteoradionecrosis, as well as for patients with high risk of NFO segment ORN.

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“…First, it was demonstrated that up to one-third of the patients who undergo radiation therapy after subcranial surgery present with osteoradionecrosis of the frontal bone segment. 25,28 Such a complication is a source of severe morbidity requiring reoperation and free flap reconstruction. Also, better emotional state and physical status after surgery may have contributed to the improved QOL scores in the endoscopic group.…”

Section: Commentmentioning

confidence: 99%

Comparison of Quality of Life After Transnasal Endoscopic vs Open Skull Base Tumor Resection

Abergel

Cavel²,

Margalit³

et al. 2012

Arch Otolaryngol Head Neck Surg

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Osteoradionecrosis of the Anterior Cranium

Cited by 8 publications

References 11 publications

Transnasal endoscopic surgery in selected nasal‐ethmoidal cancer with suspected brain invasion: Indications, technique, and outcomes

Transnasal endoscopic surgery in selected nasal‐ethmoidal cancer with suspected brain invasion: Indications, technique, and outcomes

Anterior Median Skull Base Reconstruction Using a Vascularized Free Flap: Rationale, Patient Selection and Outcome

Comparison of Quality of Life After Transnasal Endoscopic vs Open Skull Base Tumor Resection

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