Objectives: Endoscopic endonasal anterior skull base surgery has expanding use in the pediatric population, but the anatomy of pediatric patients can lead to limitations. This study aims to characterize the important anatomical implications of the pediatric skull base using computed tomography (CT) scans. Design: Retrospective analysis Setting: Tertiary academic medical center Participants: 506 patients aged 0-18 who had undergone maxillofacial and or head CTs between 2009-2016. Methods: Measurements included piriform aperture width, nare to sella distance (NSD), sphenoid pneumatization, olfactory fossa depth, lateral lamella cribriform plate angles, and intercarotid distances (ICD) at the superior clivus and cavernous sinus. These patients were then subdivided into 3 age groups adjusting for sex. ANCOVA models were fit comparing between all age groups and by sex. Results: Piriform aperture width, NSD, sphenoid sinus pneumatization as measured using lateral aeration and anterior sellar wall thickness, olfactory fossa depth, and ICD at the cavernous sinus was significantly different among all age groups (P<0.0001). Our results show that mean piriform aperture width increased with each age group. The mean olfactory fossa depth also had consistent age dependent growth. In addition, ICD at the cavernous sinus showed age dependent changes. When comparing by sexes, females consistently showed smaller measurements. Conclusion: The process of skull base development is age and sex dependent. During preoperative evaluation of pediatric patients for skull base surgery piriform aperture width, sphenoid pneumatization in both the anterior posterior and lateral directions, and ICD at the cavernous sinus should be carefully reviewed.

Background: The purpose of this study is to report outcomes of transphyseal screw hemi-epiphysiodesis at the medial malleolus for the treatment of valgus ankle deformity. Methods: An institutional review board–approved retrospective review was done of 24 patient charts. Lateral distal tibial angle (LDTA) was measured preoperatively and at final follow-up. Results: The average change in LDTA was 8.3 degrees (SD 4.9 degrees; range 0-19 degrees). The average rate of correction was 0.4 degrees per month (SD 0.3; range 0-1.4). Conclusion: Medial malleolar transphyseal screw hemiepiphysiodesis is a simple, effective, and safe treatment for valgus ankle deformity in skeletally immature children. Level of Evidence: Level IV, case series.