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

Objectives: The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study’s aim is to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents ages 0-18 years. Design: A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000-2020 using PRISMA guidelines. Final inclusion criteria included: case series with 10+ patients with pediatric patients age ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting: Tertiary care medical center Participants: Children/adolescents ages 0-18 years who underwent endoscopic skull base surgery Main Outcome Measures: Patient demographics, pathology, reconstructive technique, intra-operative findings, intra-operative and post-operative surgical complications. Results: Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients age 0-18 years met inclusion criteria for final analysis. 7 of 12 studies discussed a single pathology. The most common pathology was a skull base defect causing CSF leak. The majority of skull base repairs were made with free tissue grafts. The most common post-operative complication was CSF leak (n=40). Twelve cases of meningitis occurred post-operatively with two of these episodes resulting in death. Conclusions: Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

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Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

American Journal of Rhinology and Allergy ◽

10.1177/1945892420908749 ◽

2020 ◽

Vol 34 (4) ◽

pp. 487-493 ◽

Cited By ~ 1

Author(s):

Erin K. Reilly ◽

Colin T. Huntley ◽

Maurits S. Boon ◽

Gregory Epps ◽

Swar Vimawala ◽

...

Keyword(s):

Continuous Positive Airway Pressure ◽

Nasal Cavity ◽

Skull Base ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Skull Base Surgery ◽

Healthy Individuals ◽

Significant Difference ◽

The Impact ◽

Cadaveric Model

Background For patients with obstructive sleep apnea (OSA), there is a lack of knowledge regarding the impact of continuous positive airway pressure (CPAP) on the nasal cavity. There is a significant need for evidence-based recommendations regarding the appropriate use of CPAP following endoscopic sinus and skull base surgery. Objective The goal of this study is to translate a previously developed cadaveric model for evaluating CPAP pressures in the sinonasal cavity by showing safety in vivo and quantifying the effect of positive pressurized air flow on the nasal cavity of healthy individuals where physiologic effects are at play. Methods A previously validated cadaveric model using intracranial sensor catheters has proved to be a reliable technique for measuring sinonasal pressures. These sensors were placed in the nasal cavity of 18 healthy individuals. Pressure within the nose was recorded at increasing levels of CPAP. Results Overall, nasal cavity pressure was on average 85% of delivered CPAP. The amount of pressure delivered to the nasal cavity increased as the CPAP increased. The percentage of CPAP delivered was 77% for 5 cmH2O and increased to 89% at 20 cmH2O. There was a significant difference in mean intranasal pressures between all the levels of CPAP except 5 cmH2O and 8 cmH2O ( P < .001). Conclusion On average, only 85% of the pressure delivered by CPAP is transmitted to the nasal cavity. Higher CPAP pressures delivered a greater percentage of pressurized air to the nasal cavity floor. Our results are comparable to the cadaver model, which demonstrated similar pressure delivery even in the absence of anatomic factors such as lung compliance, nasal secretions, and edema. This study demonstrates the safety of using sensors in the human nasal cavity. This technology can also be utilized to evaluate the resiliency of various repair techniques for endoscopic skull base surgery with CPAP administration.

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Review of skull base surgery approaches: With special reference to pediatric patients

Journal of Neuro-Oncology ◽

10.1007/bf01053045 ◽

1994 ◽

Vol 20 (3) ◽

pp. 291-312 ◽

Cited By ~ 20

Author(s):

Jerone D. Kennedy ◽

Stephen J. Haines

Keyword(s):

Special Reference ◽

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery

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From Krönlein, through madness, to a useful modern surgery: the journey of the transorbital corridor to enter the neurosurgical armamentarium

Journal of Neurosurgery ◽

10.3171/2020.8.jns201251 ◽

2021 ◽

pp. 1-10

Author(s):

Lena Mary Houlihan ◽

Evgenii Belykh ◽

Xiaochun Zhao ◽

Michael G. J. O’Sullivan ◽

Mark C. Preul

Keyword(s):

Patient Satisfaction ◽

Surgical Technique ◽

Skull Base ◽

Skull Base Surgery ◽

Historical Analysis ◽

Historical Origin ◽

Psychosocial Influences ◽

Minimal Invasion ◽

Surgical Corridor ◽

The Impact

Transorbital surgery has gained recent notoriety because of its incorporation into endoscopic skull base surgery. The use of this surgical corridor has been pervasive throughout the 20th century. It has been utilized by multiple disciplines for both clinical and experimental purposes, although its historical origin is medically and ethically controversial. Hermann Knapp first introduced the orbital surgical technique in 1874, and Rudolf Krönlein introduced his procedure in 1889. Rivalry between Walter Dandy in neurosurgery and Raynold Berke in ophthalmology further influenced methods of tackling intracranial and intraorbital pathologies. In 1946, Walter Freeman revolutionized psychosurgery by completing seemingly successful transorbital leucotomies and promoting their minimally invasive and benign surgical characteristics. However, as Freeman’s legacy came into disrepute, so did the transorbital brain access corridor, again resulting in its stunted evolution. Microsurgery and endoscopy further influenced the use, or lack thereof, of the transorbital corridor in neurosurgical approaches. Historical analysis of present goals in modern skull base surgery echoes the principles established through an approach described almost 150 years ago: minimal invasion, minimal morbidity, and priority of patient satisfaction. The progression of the transorbital approach not only reflects psychosocial influences on medical therapy, as well as the competition of surgical pioneers for supremacy, but also describes the diversification of skull base techniques, the impact of microsurgical mastery on circumferential neurosurgical corridors, the influence of technology on modernizing skull base surgery, and the advancing trend of multidisciplinary surgical excellence.

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Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2016.12.019 ◽

2017 ◽

Vol 93 ◽

pp. 163-166 ◽

Cited By ~ 20

Author(s):

Amanda L. Stapleton ◽

Elizabeth C. Tyler-Kabara ◽

Paul A. Gardner ◽

Carl H. Snyderman ◽

Eric W. Wang

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Leak ◽

Endoscopic Endonasal ◽

Fluid Leak

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138 Endoscopic Endonasal Skull Base Surgery in Pediatric Patients and Impact on Midface Growth

Neurosurgery ◽

10.1093/neuros/nyx417.138 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 232-232

Author(s):

Wendy Chen ◽

Shih-Dun Liu ◽

Barton F Branstetter ◽

Yue-Fang Chang ◽

Lindsay A Schuster ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

Score Test ◽

Growth Period ◽

Cranial Base ◽

Tumor Type ◽

Endoscopic Endonasal ◽

Significant Difference ◽

Maxilla And Mandible

Abstract INTRODUCTION Cranial base development plays a large role in anterior and vertical maxillary growth through age 7, and the effect of early endonasal cranial base surgery on midface growth is unknown. We present our experience with pediatric endoscopic endonasal surgery and long-term midface growth. METHODS This is a retrospective review (2000-2016). Pediatric patients were grouped by age at first endoscopic endonasal skull base surgery (<7 yo and >7 yo). Included patients had both pre- and post-operative (>1 yr) imaging. Radiologists performed measurements (Sella-Nasion distance and angles from S-N to maxilla and mandible (SNA, SNB, ANB)), which were compared to age- and sex-matched Bolton standards. Z score test was used; significance was set at P < 0.05. RESULTS >The <7 yo group had 11 patients, averaging follow-up of 5 yrs; the >7 yo group had 33 patients. Most tumors were benign; one patient with a panclival AVM was a significant outlier for all measurements. Comparing the <7 yo group to Bolton standard norms, there was no significant difference in post-operative SNA (P = 0.10), SNB (P = 0.14), or ANB (0.67). SN distance was reduced both pre- and post-operatively (SD = 1.5, P = 0.01 and P = 0.009). Sex had no significant effect. Compared to patients who had surgery in the >7 yo group, the <7 yo group demonstrated no significant difference in pre- to post-operative changes with regard to S-N (P = 0.87), SNA (P = 0.89), and ANB (P = 0.14). Tumor type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group. CONCLUSION Though our cohort of patients with skull base tumors demonstrate some abnormal measurements before their operation, their post-operative cephalometrics fall within normal standard deviations and generally have no significant difference compared to patients who underwent operations at an older age. Therefore, there appears to be no evidence of impact of endoscopic endonasal skull base surgery on craniofacial development within the growth period studied.

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