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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
The impact of expanded endonasal skull base surgery on midfacial growth in pediatric patients
Arjun K Parasher1,2, David K Lerner3, Jordan T Glicksman4,5
1Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.
Insights
The expanded endonasal approach (EEA) for pediatric skull base tumor resection does not negatively impact midfacial growth. This minimally invasive technique shows comparable outcomes to traditional open surgery regarding facial development.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Skull Base Surgery
Background:
- Expanded endonasal approach (EEA) is increasingly used for pediatric skull base tumor resection.
- Concerns exist regarding potential iatrogenic damage to nasal growth zones and its effect on midfacial growth.
Purpose of the Study:
- To evaluate the effect of EEA on midfacial growth in pediatric patients.
- To compare midfacial growth following EEA versus open transcranial approaches for tumor resection.
Main Methods:
- Retrospective review of pediatric patients undergoing craniopharyngioma resection.
- Comparison between EEA (n=12) and open transcranial approach (n=10).
- Pre- and postoperative MRI analysis of midfacial measurements (anterior/posterior height, palatal length, sella-nasion distance) over 3 years.
Main Results:
- No significant difference in midfacial growth was observed between EEA and open transcranial groups.
- Specific measurements (anterior midface height, posterior midface height, palatal length, sella-nasion distance) showed no statistically significant divergence between the surgical approaches.
Conclusions:
- EEA is a safe alternative to traditional transcranial approaches for pediatric skull base tumor resection concerning midfacial growth.
- Further long-term studies with larger cohorts are needed to fully elucidate the implications of EEA on skull base development.
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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