Classifications of Postradiation Nasopharyngeal Necrosis for Guiding Transnasal Endoscopic Nasopharyngeal Skull Base Surgery.

Objective: Postradiation nasopharyngeal necrosis (PRNN) is a severe postradiation complication of nasopharyngeal carcinoma. PRNN not only severely impacts the quality of life but also endangers the lives of patients. Definite grades of PRNN and their corresponding standard surgical procedures are lacking. we aimed to establish the classifications of PRNN for transnasal endoscopic skull base surgery (TESS).

Methods: We enrolled 82 postirradiation NPC patients with PRNN, 75 of whom received TESS. PRNN was categorized into four grades: I, necrosis of the nasopharyngeal mucosa and submucosal muscularis; II, necrosis extending to the pharyngobasilar fascia; III, necrotic area breaking through the pharyngobasilar fascia and involving the internal carotid artery (ICA); IV, necrosis encompassing the ICA or invading the posterior cranial nerves. Overall survival (OS) analysis based on the PRNN grades was assessed. Headache was assessed using a numeric rating scale.

Results: The classifications of PRNN were as follows: Grade I, 18.3% (n = 15); Grade II, 30.5% (n = 25); Grade III, 24.4% (n = 20); Grade IV, 26.8% (n = 22). After surgery, headache was alleviated in most PRNN patients to varying degrees. By the last follow-up visit, 24 patients had died, including 6 of 7 in the unoperated group and 18 out of 75 in the operated group.

Conclusion: The classifications of PRNN grade provide an effective guideline for the TESS treatment of PRNN.

Level of evidence: 4 Laryngoscope, 2024.