Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth

2019 ◽  
Vol 23 (4) ◽  
pp. 523-530 ◽  
Author(s):  
Wendy Chen ◽  
Paul A. Gardner ◽  
Barton F. Branstetter ◽  
Shih-Dun Liu ◽  
Yue Fang Chang ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Base ◽  
Early Surgery ◽  
Endoscopic Endonasal ◽  
Anterior Maxilla ◽  
Surgery Group ◽  
Significant Difference

OBJECTIVECranial base development plays a large role in anterior and vertical maxillary growth through 7 years of age, and the effect of early endonasal cranial base surgery on midface growth is unknown. The authors present their experience with pediatric endoscopic endonasal surgery (EES) and long-term midface growth.METHODSThis is a retrospective review of cases where EES was performed from 2000 to 2016. Patients who underwent their first EES of the skull base before age 7 (prior to cranial suture fusion) and had a complete set of pre- and postoperative imaging studies (CT or MRI) with at least 1 year of follow-up were included. A radiologist performed measurements (sella-nasion [S-N] distance and angles between the sella, nasion, and the most concave points of the anterior maxilla [A point] or anterior mandibular synthesis [B point], the SNA, SNB, and ANB angles), which were compared to age- and sex-matched Bolton standards. A Z-score test was used; significance was set at p < 0.05.RESULTSThe early surgery group had 11 patients, with an average follow-up of 5 years; the late surgery group had 33 patients. Most tumors were benign; 1 patient with a panclival arteriovenous malformation was a significant outlier for all measurements. Comparing the measurements obtained in the early surgery group to Bolton standard norms, the authors found no significant difference in postoperative SNA (p = 0.10), SNB (p = 0.14), or ANB (0.67) angles. The S-N distance was reduced both pre- and postoperatively (SD 1.5, p = 0.01 and p = 0.009). Sex had no significant effect. Compared to patients who had surgery after the age of 7 years, the early surgery group demonstrated no significant difference in pre- to postoperative changes with regard to S-N distance (p = 0.87), SNA angle (p = 0.89), or ANB angle (p = 0.14). Lesion type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group.CONCLUSIONSThough our cohort of patients with skull base lesions demonstrated some abnormal measurements in the maxillary-mandibular relationship before their operation, their postoperative cephalometrics fell within the normal range and showed no significant difference from those of 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.

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

Neurosurgery ◽  
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.

Endoscopic endonasal skull base surgery in the pediatric population

2013 ◽  
Vol 11 (3) ◽  
pp. 227-241 ◽  
Author(s):  
Srinivas Chivukula ◽  
Maria Koutourousiou ◽  
Carl H. Snyderman ◽  
Juan C. Fernandez-Miranda ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Skull Base ◽  
Pituitary Adenomas ◽  
Skull Base Surgery ◽  
Pediatric Population ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
The Mean

Object The use of endoscopic endonasal surgery (EES) for skull base pathologies in the pediatric population presents unique challenges and has not been well described. The authors reviewed their experience with endoscopic endonasal approaches in pediatric skull base surgery to assess surgical outcomes and complications in the context of presenting patient demographics and pathologies. Methods A retrospective review of 133 pediatric patients who underwent EES at our institution from July 1999 to May 2011 was performed. Results A total of 171 EESs were performed for skull base tumors in 112 patients and bony lesions in 21. Eighty-five patients (63.9%) were male, and the mean age at the time of surgery was 12.7 years (range 2.3–18.0 years). Skull base tumors included angiofibromas (n = 24), craniopharyngiomas (n = 16), Rathke cleft cysts (n = 12), pituitary adenomas (n = 11), chordomas/chondrosarcomas (n = 10), dermoid/epidermoid tumors (n = 9), and 30 other pathologies. In total, 19 tumors were malignant (17.0%). Among patients with follow-up data, gross-total resection was achieved in 16 cases of angiofibromas (76.2%), 9 of craniopharyngiomas (56.2%), 8 of Rathke cleft cysts (72.7%), 7 of pituitary adenomas (70%), 5 of chordomas/chondrosarcomas (50%), 6 of dermoid/epidermoid tumors (85.7%), and 9 cases of other pathologies (31%). Fourteen patients received adjuvant radiotherapy, and 5 received chemotherapy. Sixteen patients (15.4%) showed tumor recurrence and underwent reoperation. Bony abnormalities included skull base defects (n = 12), basilar invagination (n = 4), optic nerve compression (n = 3) and trauma (n = 2); preexisting neurological dysfunction resolved in 12 patients (57.1%), improved in 7 (33.3%), and remained unchanged in 2 (9.5%). Overall, complications included CSF leak in 14 cases (10.5%), meningitis in 5 (3.8%), transient diabetes insipidus in 8 patients (6.0%), and permanent diabetes insipidus in 12 (9.0%). Five patients (3.8%) had transient and 3 (2.3%) had permanent cranial nerve palsies. The mean follow-up time was 22.7 months (range 1–122 months); 5 patients were lost to follow-up. Conclusions Endoscopic endonasal surgery has proved to be a safe and feasible approach for the management of a variety of pediatric skull base pathologies. When appropriately indicated, EES may achieve optimal outcomes in the pediatric population.

scholarly journals Endoscopic endonasal resection of midline cranial base tumors

2018 ◽  
Vol 19 (2) ◽  
pp. 7-17
Author(s):  
Enrico De Divitiis ◽  
Felice Esposito ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Oreste De Divitiis ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Visual Deficits ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base ◽  
Subtotal Removal

Objective: The advent of the endoscope in transsphenoidalsurgery has permitted to expand the indications of such approach also for the treatment of on tumors located in supra, para, retro and infrasellar regions, enabling the neurosurgeon to work under direct visual control in a minimally invasive way. Since 2004 we have started to use the extended endonasal transsphenoidal approach for a variety of lesions involving the midline skull base and, in particular, the suprasellar area, the cavernous sinus and the retroclival prepontine region. Methods: Over a 36-month period, sixty-four procedures have been performed. The series consisted of 29 males and 35 females, aged from 24 to 80 years (median 49.8 years). The mean follow-up was of 18 months (ranging from 3 to 36 months). Among the patients with midline lesions, who were 90.6 % of the total, seven patients had a pituitary adenoma, sixteen patients were affected by a craniopharyngioma, six patients had a suprasellar Rathke’s cleft cyst, seven subjects had a tuberculum sellae meningioma, four had an olfactorygroove meningioma, and six a clival tumor. Other lesions ofthe midline skull base were, 1 chiasmatic astrocytoma, 1 neuroendocrine tumor, 4 post-traumatic cerebro-spinal fluid rhinorrhea, and one optic nerve glioma. Three other patients had anterior cranial base meningoencephaloceles. Results: Overall, gross total removal of the lesion was achieved in 30/49 tumoral lesions (61.2%); subtotal removal was achieved in 12/49 cases (24.5%). The three cases of meningoencephaloceles were all successfully treated. Among the patients with preoperative visual deficits, most of them fully recovered or improved and only two worsened in one eye. Major complications consisted in 2 deaths (one not directly related with the surgical procedure), 6 postoperative CSF leak (one complicated with bacterial meningitis), one ICA injury, and 6 cases of permanent diabetes insipidus.Conclusion: The extended transsphenoidal approach tothe supra and parasellar lesions seems Endoscopy; Transsphenoidal surgery; Extended approach; Parasellar; Tumors; Anterior skull base. A promising minimally invasivetechnique for the removal of lesions affecting these areas,once thought to be suitable only of the transcranial routes.Concerning the lesion removal and the recurrence rate compared with the transcranial routes, it is too early to pose a definitive word, since the follow-up is still too short.

Current Surgical Outcomes for Cranial Base Chordomas

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. 1355-1360 ◽  
Author(s):  
Salvatore Di Maio ◽  
Robert Rostomily ◽  
Laligam N. Sekhar
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Cranial Base ◽  
Controlled Study ◽  
Karnofsky Performance Scale ◽  
Free Survival ◽  
Entire Cohort ◽  
Significant Difference ◽  
Performance Scale

Abstract BACKGROUND: Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. OBJECTIVE: To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. METHODS: From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. RESULTS: Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). CONCLUSION: Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS.

Synthes Skull Base Surgery Award 113 Long-term Follow-up of Male Patients with Prolactinomas

Neurosurgery ◽  
2014 ◽  
Vol 61 ◽  
pp. 196
Author(s):  
Lukas Andereggen ◽  
Janine Frey ◽  
Robert H. Andres ◽  
Marwan El-Koussy ◽  
Emanuel Christ
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Long Term Follow Up ◽  
Male Patients

Management of Malignant Schwannomas of the Paranasal Sinuses and Anterior Skull Base

1996 ◽  
Vol 75 (6) ◽  
pp. 377-380 ◽  
Author(s):  
Laurence J. DiNardo ◽  
Robert L. Rumsey
Keyword(s):  
Skull Base ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Skull Base Surgery ◽  
Anterior Skull Base ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Low Incidence

The evolution of skull base surgery has facilitated the extirpation of previously unresectable tumors. As experience with skull base surgery increases, the feasibility of resection and long-term outcomes is becoming apparent for the more common lesions. Neoplasms such as malignant schwannomas are rare and, therefore, defy single-institution analysis. The treatment and four-year follow-up of a malignant paranasal sinus and anterior skull base schwannoma is described. Analysis of the literature confirms the low incidence of this tumor and supports the efficacy of skull base surgery in its treatment.

Long-Term Olfactory Outcome after Nasoseptal Flap Reconstructions in Midline Skull Base Surgery

2017 ◽  
Vol 31 (5) ◽  
pp. 334-337 ◽  
Author(s):  
Michael B. Soyka ◽  
Carlo Serra ◽  
Luca Regli ◽  
Eva Meier ◽  
David Holzmann
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Nasoseptal Flap ◽  
Nasal Breathing ◽  
Donor Side ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up

Background The nasoseptal flap (NSF) is a universally used surgical technique to cover defects of the skull base after extended sinonasal surgery. Long-term follow-up of complications, sequelae, and smell function is largely unknown. Objective The main objective of this study was to investigate monorhinal olfaction after transsphenoidal skull base surgery. Methods Patients who underwent skull base surgery for midline lesions (craniopharyngioma and pituitary tumors) by using a NSF, also referred to as the Haddad flap, were assessed for their long-term outcome. Endoscopic examination was conducted and the bilateral “Sniffin’ Sticks” test was performed before surgery. Each side was tested separately in the postoperative follow-up consultation. Results Twenty patients were included in the study. No flap failures were observed. One anterior perforation and one small posterior septal perforation were found during long-term follow-up. None of the patients had nasal breathing impairment, whereas two patients had nose bleeds. A significant decrease in olfactory function was observed on the flap donor side in four patients (20%) compared with that observed in one patient (5%) on the opposite side. Conclusion NSF reconstructions for midline lesions were efficient and safe in the long term. Olfactory impairment on the donor side was frequently encountered. Although subclinical, these findings justified a monorhinal smell testing before surgery, which possibly prevented bilateral smell impairment in patient with preexisting single-sided olfactory loss.

Utility of Early Postoperative Imaging after Combined Endoscopic and Open Ventral Skull Base Surgery

2017 ◽  
Vol 31 (3) ◽  
pp. 186-189 ◽  
Author(s):  
Zachary S. Mendelson ◽  
Kristen A. Echanique ◽  
Meghan M. Crippen ◽  
Alejandro Vazquez ◽  
James K. Liu ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Skull Base ◽  
Clinical Symptoms ◽  
Skull Base Surgery ◽  
False Negative ◽  
True Negative ◽  
Endoscopic Endonasal ◽  
Postoperative Imaging ◽  
Significant Difference ◽  
Ventral Skull Base

Purpose Immediate postoperative imaging is frequently obtained after combined skull base surgery (SBS) with endoscopic endonasal and open transcranial approaches. The importance of early postoperative imaging for detecting complications in these patients is still debatable. In this study, we investigated the clinical utility of early postoperative imaging after combined SBS for determination of postoperative complications. Methods A retrospective chart analysis of 21 cases of combined SBS between 2009 and 2015 was performed. Data on postoperative computed tomography (CT) and magnetic resonance imaging (MR), and the hospital course were collected. We separated interpretations of postoperative imaging into two groups: (1) when using the radiologist's interpretation alone, and (2) when using the surgeon's knowledge of the case in conjunction with imaging. Results Forty-two postoperative scans were obtained (21 CT, 21 MR) within 48 hours of surgery. There was a significant statistical difference between imaging interpretation by surgeons and radiologists for CT interpretation only. For CT interpretation the true positive (TP), false positive (FP), true negative (TN), and false negative (FN) rates for radiologists (TP, 0/21; FP, 6/21; TN, 11/21; FN, 4/21) slightly deviated from surgeons' interpretation (TP, 1/21 [p = 0.9999]; FP, 0/21 [p = 0.0207]; TN, 17/21 [p = 0.1000]; FN, 3/21 [p = 1.000]). Rates for MRI interpretation by both groups were nearly identical, with no significant difference found. Overall, four patients experienced seven postoperative complications, which led to a complication rate of 19.0% (4/21). The patients exhibited clinical symptoms in all instances of postoperative complications that required further intervention. Conclusion The benefit of early postoperative imaging to detect complications after combined SBS was limited. In this cohort of patients, positive imaging findings' effects on patient management were dictated by the presence of supporting clinical symptoms.

Straws Don't Suck: Are Straws Dangerous after Endoscopic Skull Base Surgery?

2020 ◽  
Author(s):  
Erin K. Reilly ◽  
Judd H. Fastenberg ◽  
Mindy R. Rabinowitz ◽  
Colin T. Huntley ◽  
Maurits S. Boon ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Skull Base ◽  
Negative Pressure ◽  
Skull Base Surgery ◽  
Pressure Measurements ◽  
Average Pressure ◽  
Endoscopic Endonasal ◽  
Endoscopic Skull Base Surgery ◽  
Significant Difference ◽  
Pressure Dynamics

Abstract Objective Patients undergoing endoscopic endonasal surgery have historically been restricted from using straws postoperatively, due to the concern that this activity generates negative pressure. The objective of this study is to evaluate the pressure dynamics in the sinonasal cavity associated with the use of a straw. Methods Intracranial pressure catheters were placed in the nasal cavity of 20 healthy individuals. Pressure measurements were then recorded while participants drank liquids of different viscosities from a cup and from a straw. Measurements were recorded with and without subjects occluding their nose to simulate postoperative nasal obstruction. Results The average pressure in the nasal cavity while drinking water from a cup was −0.86 cmH2O, from a straw was −1.09 cmH2O, and while occluding the nose and using a straw was −0.81 cmH2O. The average pressure in the nasal cavity while drinking a milkshake from a cup was −0.98 cmH2O, from a straw was −1.88 cmH2O, and while occluding the nose and using a straw was −1.37 cmH2O. There was no statistically significant difference in pressure measurements when comparing either task or consistency (p > 0.05). Conclusion Straw use is not associated with the generation of significant negative pressure in the nasal cavity. The pressure generated when drinking from a straw is not significantly different from that of drinking from a cup. This data suggest that straw use may be safe for patients following endoscopic skull base surgery, but further investigation is warranted.

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