The expanded endonasal approach for the treatment of intracranial skull base disease in the pediatric population

Khalili, Sammy; Palmer, James N.; Adappa, Nithin D.

doi:10.1097/moo.0000000000000126

Cited by 17 publications

(37 citation statements)

References 16 publications

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“…Pediatric skull base tumors are a rare entity, representing only 5% to 6% of all skull base tumors . The most common benign pathologies include craniopharyngiomas, nerve sheath tumors, and juvenile nasopharyneal angiofibroma, whereas the most prevalent malignant pathologies include chondrosarcoma, chordoma, and rhabdomyosarcoma . Typically, treatment of pediatric skull base tumors is accomplished via surgical resection, historically carried out through an open approach.…”

Section: Introductionmentioning

confidence: 99%

“…Typically, treatment of pediatric skull base tumors is accomplished via surgical resection, historically carried out through an open approach. More recently, the expanded endoscopic approach (EEA) has gained in favor due to improved endoscopic techniques and the benefits of minimizing several potential morbidities associated with open procedures . Serious intraoperative complications of EEA to the skull base are rare, but can involve damage to critical neurovascular structures including the internal carotid artery, optic nerves or chiasm, or other cranial nerves …”

Section: Introductionmentioning

confidence: 99%

“…This has led many to propose that incomplete sphenoid sinus pneumatization represents a relative contraindication to the EEA due to the theoretical increased risk of major intraoperative complications . However, more recent proficiency with endoscopic access and widespread adoption of intraoperative navigational imaging appears to have augmented the skull base surgeon's ability to safely perform skull base resection in even the youngest of patients …”

Section: Introductionmentioning

confidence: 99%

“…1 The most common benign pathologies include craniopharyngiomas, nerve sheath tumors, and juvenile nasopharyneal angiofibroma, whereas the most prevalent malignant pathologies include chondrosarcoma, chordoma, and rhabdomyosarcoma. 1,2 Typically, treatment of pediatric skull base tumors is accomplished via surgical resection, historically carried out through an open approach. More recently, the expanded endoscopic approach (EEA) has gained in favor due to improved endoscopic techniques and the benefits of minimizing several potential morbidities associated with open procedures.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, the expanded endoscopic approach (EEA) has gained in favor due to improved endoscopic techniques and the benefits of minimizing several potential morbidities associated with open procedures. [1][2][3] Serious intraoperative complications of EEA to the skull base are rare, but can involve damage to critical neurovascular structures including the internal carotid artery, optic nerves or chiasm, or other cranial nerves. 3,4 A unique aspect of applying EEA to pediatric skull base tumors is the variable degree of sphenoid sinus development.…”

Section: Introductionmentioning

confidence: 99%

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Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

et al. 2018

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Objectives/Hypothesis Currently, due to the rarity of pathology, there are limited data surrounding outcomes of pediatric skull base surgery. Traditionally, surgeons have proceeded with caution when electing endonasal endoscopic transsellar/transplanum approaches to the skull base in pediatric patients due to poor sphenoid pneumatization. In this study, we review outcomes of endoscopic pediatric skull base surgery based on sphenoid pneumatization patterns. Study Design Retrospective chart review. Methods A review of all cases of pediatric (age < 18 years) craniopharyngioma managed via an endoscopic endonasal approach at a tertiary academic medical center. Results A total of 27 patients were included in the analysis. The median age was 8 years. Nineteen (70%) patients were male. Presellar, sellar/postsellar, and conchal sphenoid pneumatizations were found in 6, 11, and 10 patients, respectively. There was no significant association between sphenoid pneumatization pattern and extent of resection (gross vs. subtotal, P = .414), postoperative cerebrospinal fluid (CSF) leak (P = .450), intraoperative estimated blood loss (P = .098), total operative time (P = .540), and length of stay (P = .336). On multivariate analysis, after accounting for age, sex, preoperative cranial nerve involvement, and cavernous sinus invasion, there remained no significant association between sphenoid pneumatization pattern and extent of resection (P = .999) and postoperative CSF leak (P = .959). Conclusions Sphenoid pneumatization pattern does not appear to affect outcomes in endoscopic skull base surgery in the pediatric population. Importantly, lack of sphenoid pneumatization does not impede gross total resection or increase complications. Thorough knowledge of the anatomy during the endoscopic approach is critical to optimize outcomes. Level of Evidence 4 Laryngoscope, 129:832–836, 2019

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

et al. 2018

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Comparison of high‐flow CSF leak closure with nasoseptal flap following endoscopic endonasal approach in adult and pediatric populations

Papagiannopoulos

Tong

Brown

et al. 2021

Int Forum Allergy Rhinol

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The impact of expanded endonasal skull base surgery on midfacial growth in pediatric patients

et al. 2019

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Objective Surgical resection of skull base tumors in children is increasingly accomplished through an expanded endonasal approach (EEA). We aim to evaluate the potential effect of the EEA on midfacial growth as a result of iatrogenic damage to nasal growth zones. Methods We performed a retrospective review of children undergoing craniopharyngioma resection via an open transcranial or EEA. Pre‐ and postoperative magnetic resonance imaging was evaluated for growth in four midfacial measurements based on established cephalometric landmarks: anterior midface height, posterior midface height, palatal length, and sella–nasion distance. Statistical analysis was conducted using a mixed‐effects linear regression model. Results Twenty‐two patients underwent an EEA (n = 12) or open transcranial approach (n = 10) for tumor resection with 3 years of imaging follow‐up. There was no difference in midfacial growth between groups for each measurement. Compared to the open group, patients undergoing EEA demonstrated relative anterior midface height growth of −0.42 mm (P = 0.880), posterior midface height growth of −0.44 mm (P = 0.839), palatal length growth of 0.35 mm (P = 0.894), and sella–nasion distance growth of −2.16 (P = 0.365). Conclusion We found no difference in midfacial growth measurements between patients undergoing craniopharyngioma resection via an EEA and the open transcranial route after 3 years of imaging follow‐up. Preliminary results on midfacial growth demonstrate that the EEA is a safe alternative to traditional transcranial approaches for the pediatric population. Further investigation with larger sample size and longer duration of follow‐up is warranted to more thoroughly investigate the long‐term implications of the EEA to the skull base. Level of Evidence 3 Laryngoscope, 130:338–342, 2020

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The expanded endonasal approach for the treatment of intracranial skull base disease in the pediatric population

Cited by 17 publications

References 16 publications

Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

Comparison of high‐flow CSF leak closure with nasoseptal flap following endoscopic endonasal approach in adult and pediatric populations

The impact of expanded endonasal skull base surgery on midfacial growth in pediatric patients

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