CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(03): e109-e112
DOI: 10.1055/a-2164-8637
Case Report

Anterior Skull Base Osteoradionecrosis in the Age of Intensity-Modulated Radiation Therapy: A Case Series

Nikitha Kosaraju
1   David Geffen School of Medicine at UCLA, Los Angeles, California, United States
Huan Zhang
2   Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States
Sharon Qi
3   Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California, United States
Robert Chin
3   Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California, United States
Marilene B. Wang
2   Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States
› Institutsangaben


Background Despites advances in radiation technology, skull base osteoradionecrosis (ORN) continues to be a rare, devastating, and hard to treat complication of radiotherapy. We present three cases of anterior skull base ORN in a cohort treated with intensity-modulated radiation therapy (IMRT).

Case Series Three patients developed anterior skull base ORN after receiving at least one round of IMRT. ORN was diagnosed through either nasal endoscopy or imaging findings. The first was a 59-year-old woman with a sinonasal squamous cell carcinoma. Her chemoradiation history was notable for reirradiation and a high dose of radiation (143.3 Gy). The second was a 55-year-old man with recurrent nasopharyngeal carcinoma, whose history was notable for a high dose of radiation (∼140 Gy) and for being reirradiated. The final patient was a 37-year-old woman with an unremarkable history who received radiotherapy (65.0 Gy) for an esthesioneuroblastoma. One patient was asymptomatic and did not receive ORN-specific therapy. The other two were treated with a combination of medical and surgical intervention with successful short-term outcomes (no evidence of infection).

Conclusion Anterior skull base ORN can be treated through conservative and surgical means to achieve successful short-term outcomes. Further investigation of long-term outcomes is warranted.


This study was presented at the AAO-HNSF 2022 Annual Meeting and OTO Experience, Philadelphia, Pennsylvania, September 10–14, 2022.


Eingereicht: 10. August 2023

Angenommen: 29. August 2023

Accepted Manuscript online:
01. September 2023

Artikel online veröffentlicht:
27. September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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