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Reconstruction of pediatric skull base defects: A retrospective analysis emphasizing the very young
Nyall R London1, Gustavo G Rangel2, Amanda Onwuka3
1Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA; Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD, USA.
Insights
Pediatric skull base reconstruction presents unique challenges, especially in children under six. This study highlights increased risks like CSF leaks and the need for specialized techniques in younger patients.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Otolaryngology
Background:
- Pediatric skull base pathology is rare, encompassing congenital, malignant, and traumatic defects.
- Younger children (≤6 years) pose distinct anatomical challenges for skull base surgeons.
- Understanding these challenges is crucial for successful surgical outcomes.
Purpose of the Study:
- To retrospectively review surgical experience with pediatric skull base defect reconstruction.
- To specifically emphasize outcomes in patients ≤6 years of age.
- To identify challenges and effective reconstructive strategies in this population.
Main Methods:
- Retrospective chart review of patients ≤20 years undergoing skull base surgery (2007-2018).
- Patients divided into two groups: ≤6 years (Group A) and >6 to ≤20 years (Group B).
- Analysis of reconstructive techniques and patient outcomes.
Main Results:
- Higher intraoperative CSF leak rates in Group A (50%) vs. Group B (32.7%).
- Increased use of vascularized flaps in Group A (66.7%) compared to Group B (38.8%).
- Higher lumbar drain utilization in Group A (50%) vs. Group B (18.4%); behavioral issues noted in younger patients.
Conclusions:
- Pediatric skull base reconstruction, especially in patients ≤6 years, involves significant anatomical and behavioral challenges.
- The findings underscore the need for tailored surgical approaches in very young patients.
- Specialized techniques and careful management are essential for optimizing outcomes in this cohort.
Introduction:
Pathology of the pediatric skull base is rare and ranges from congenital defects to malignancy and traumatic defects. Pediatric patients, particularly those ≤6 years of age, present a unique set of anatomic challenges for the skull base surgeon. The goal of this study was to retrospectively review our experience with reconstruction of pediatric skull base defects with particular emphasis on those ≤6 years of age.
Methods:
A retrospective chart review was conducted of patients ≤20 years of age who underwent endoscopic endonasal and combined endoscopic and open approaches to address cranial base pathology from 2007 to 2018. Patients were divided into two groups; those ≤6 years of age (group A) and those >6 years of age and ≤20 years of age (group B) and reconstructive techniques and outcomes were analyzed.
Results:
Intraoperative communication with the subarachnoid space (CSF leak) was created in 50% (3/6) of patients ≤ 6 years of age compared to 32.7% (16/49) in patients > 6 years and ≤20 years of age (P < 0.40) in management of their skull base disease. A vascularized flap was utilized for reconstruction in 66.7% (4/6) of patients ≤ 6 years of age and included a nasoseptal flap in 33.3% (2/6). A vascularized flap was utilized for reconstruction in 38.8% (19/49) of patients > 6 years and ≤20 years of age and most commonly included a nasoseptal flap (22.4%, 11/49). A lumbar drain was utilized in 50% (3/6) of patients ≤ 6 years of age compared to 18.4% (9/49) in patients > 6 and ≤20 years of age (P < 0.08). Post-operative CSF leaks were encountered in 16.7% (1/6) of patients ≤ 6 years of age compared to 10.2% (5/49) in patients > 6 and ≤20 years of age (P < 0.63). Behavioral issues were noted to potentially contribute to failed skull base reconstruction in patients <6 years of age.
Conclusions:
Pediatric patients, particularly those ≤6 years of age, present a unique set of anatomic and behavioral challenges for the skull base surgeon as highlighted in this study.
