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Published on: July 5, 2021
Surgery of Anterior Skull Base Lesions in Children
Thomas Karl Hoffmann1, Marc Oliver Scheithauer1, Fabian Sommer1
11 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Medical Center, Ulm, Germany.
Insights
Surgical resection of anterior skull base lesions in children, including nasal fistulas and cysts, yielded excellent outcomes. An interdisciplinary approach ensures optimal functional and aesthetic results with no recurrence.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Otolaryngology
Background:
- Anterior skull base lesions are rare craniofacial pathologies.
- Signs include facial midline tumors, meningitis, or CSF leaks, indicating conditions like dermoid cysts, gliomas, encephaloceles, or nasal fistulas.
Purpose of the Study:
- To present a case series of pediatric anterior skull base lesions.
- To evaluate surgical treatment outcomes and establish a systematic approach.
Main Methods:
- Surgical resection of 13 pediatric anterior skull base lesions (ages 4 months to 12 years).
- Lesions included nasal fistulae, cysts, aneurysmal bone cyst, nasal glioma, and meningoencephalocele.
- Surgical approaches included transnasal, transcutaneous, and transcranial routes with reconstruction.
Main Results:
- All lesions were successfully resected with no intraoperative complications.
- Dural defects were managed with Onlay-technique or GAP-CAS technique.
- Long-term follow-up showed no recurrence of lesions.
Conclusions:
- Congenital anterior skull base pathologies are rare and present diagnostic challenges.
- An interdisciplinary surgical approach is crucial for optimal functional and aesthetic results.
- A systematic algorithm aids in managing these complex cases.
Introduction:
Lesions affecting the anterior skull base represent a rare group of craniofacial pathologies. A tumor of the facial midline, meningitis, or rhinoliquorrhea may be indicative of malformations like dermoid cysts, gliomas, encephaloceles, or nasal fistulas.
Methods:
We present a case series of 13 children (4 months to 12 years; 8 males, 5 females) with lesions involving the anterior skull base, which were treated surgically in an interdisciplinary setting. This case series includes cases of nasal fistulae (n = 5), nasal cysts (n = 5), aneurysmal bone cyst, nasal glioma, and meningoencephalocele (n = 1).
Results:
All lesions were resected with a transnasal, transcutaneous, and/or transcranial approach with reconstruction of the anterior skull base if intracranial/intradural extension was detected. In 5 cases, a dura leakage was visible, which was sealed via Onlay-technique in 3 cases, whereas in 2 cases involving a greater dural defect, the GAP-CAS technique was performed. No complications occurred, and no recurrence was visible in a long-term follow-up. An algorithm for a systematic approach to these various pathologies is provided.
Conclusion:
Congenital pathologies of the anterior skull base are rare, challenging to diagnose, and present as clinical emergencies. An interdisciplinary surgical approach is needed for best functional and aesthetic results.
