Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Aatin K. Dhanda; Sean P. McKee; David Z. Allen; Omar G. Ahmed; Kurt A. Yaeger; Laura Minhui Kim; Joshua J. Kain

doi:10.1055/a-2236-6162

Journal of Neurological Surgery Reports, Table of Contents

CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(01): e11-e16
DOI: 10.1055/a-2236-6162

Case Report

Multidisciplinary Management of Total Anterior Skull Base Osteoradionecrosis

Authors

Aatin K. Dhanda

¹Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, United States
Sean P. McKee

²Department of Otorhinolaryngology – Head and Neck Surgery, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, United States
David Z. Allen

²Department of Otorhinolaryngology – Head and Neck Surgery, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, United States
Omar G. Ahmed

¹Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, United States
Kurt A. Yaeger

³Depeartment of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
Laura Minhui Kim

¹Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, United States
Joshua J. Kain

¹Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, United States

Abstract

Cases of delayed osteoradionecrosis (ORN) of the anterior skull base have unique management considerations. A 59-year-old woman with a history of basaloid squamous cell carcinoma of the sinonasal cavity with intracranial extension through the anterior skull base developed delayed radiation sequelae of anterior skull base ORN. She underwent an initial endoscopic resection in 2011 with persistent disease that required an anterior craniofacial resection with left medial maxillectomy in 2012. She had a radiologic gross total resection with microscopic residual disease at the histologic margins prompting adjuvant chemoradiotherapy to target volume doses of 66 to 70 Gy with concurrent cisplatin chemotherapy. She subsequently developed an intracranial abscess in 2021 along the anterior skull base that required a craniotomy and endoscopic debridement. Despite aggressive surgical and medical therapy, she had persistent intracranial infections and evidence of skull base ORN. She ultimately underwent a combined open bifrontal craniotomy and endoscopic resection of the necrotic frontal bone and dura followed by an anterolateral thigh free flap reconstruction with titanium mesh cranioplasty. The patient recovered well from a microvascular free-tissue reconstruction without concern for cerebrospinal fluid leak. Anterior skull base reconstruction with free tissue transfer is a commonly utilized method for oncologic resections. Here, an anterolateral free flap was effectively used to treat an anterior skull base defect secondary to a rare indication of skull base ORN.

Keywords

skull base - osteoradionecrosis - free flap

Full Text

References

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