Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma
Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma
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DOI：
10.1097/01.mlg.0000230435.71328.b9
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发表时间：
2006-09-01
期刊：
影响因子：
2.6
通讯作者：
Xu, Geng
中科院分区：
文献类型：
--
作者：
Huang, Xiao-Ming;Zheng, Yi-Qing;Xu, Geng
目的：本文旨在探讨鼻咽癌放射治疗后颅底放射性骨坏死的诊断和治疗方法。研究方法：回顾性分析15例鼻咽癌放疗后颅底ORN患者的一般情况、临床表现和治疗效果。结果：颅底ORN的常见症状为恶臭、头痛、鼻出血。内窥镜检查显示鼻咽部有骨外露或隔离。根据计算机断层扫描的特征性发现包括以下内容：骨广泛、对称或区域性破坏;骨暴露于空气腔;可以观察到隔离;实质中存在小气囊。9例接受手术治疗，其中2例死于放射后颞叶坏死，7例存活2 ~ 7年。保守治疗6例，5例为广泛颅底ORN，1例为局限性ORN，其中3例死于鼻咽出血，1例死于衰竭，2例存活3 ~ 5年。结论：颅底ORN的临床诊断主要依靠症状、CT或MRI和内窥镜检查。最终确诊依据病理学检查。手术效果最好。广泛ORN伴放射性脑损害或颅神经损害预后差。鼻咽出血和衰竭是主要死亡原因。
Objective: The objective of this study was to investigate the diagnosis and management of skull base osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC). Methods: The general information, clinical manifestations, and treatment outcomes were retrospectively evaluated in 15 patients with skull base ORN after radiotherapy for NPC. Results: The common symptoms of skull base ORN included foul odor, headache, and epistaxis. Endoscopic examination showed exposed bone or sequestration in the nasopharynx. The characteristic findings according to computed tomography included the following: bone was destroyed extensively and symmetrically or regionally; bone was exposed to the air cavity; sequestration can be observed; and small air bladder was present in the parenchyma. There were nine patients regional skull base ORN receiving surgery, two of whom died of postradiation temporal lobe necrosis and seven of whom survived for 2 to 7 years. Conservative treatments were provided to six patients, including five patients with extensive skull base ORN and one patient with regional ORN, among which three patients died of nasopharyngeal bleeding, one patient died of exhaustion, and two patients survived for 3 to 5 years. Conclusions: Clinical diagnosis of skull base ORN was based on symptoms, computed tomography, or magnetic resonance imaging and endoscopy. The final confirmation was according to pathologic examination. Surgery had the best effect. Extensive ORN accompanied by radiation brain damage or cranial nerves damage had poor prognosis. Nasopharyngeal bleeding and exhaustion were the main causes of death.