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Published on: July 5, 2021
Clinical outcomes of coblation-assisted pediatric endoscopic endonasal skull base surgery
Shixian Liu1, Ru Tang1, Song Mao1
1Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Insights
Radiofrequency coblation is a safe and effective tool for pediatric endoscopic skull base surgery. This technique significantly reduces blood loss and operating time compared to traditional methods, with no increase in complications.
Area of Science:
- Neurosurgery
- Otolaryngology
- Pediatric Surgery
Background:
- Pediatric skull base surgery presents unique challenges due to anatomical and developmental factors.
- Radiofrequency coblation offers precise tissue dissolution with minimal thermal damage, making it suitable for delicate pediatric procedures.
Purpose of the Study:
- To evaluate the clinical outcomes of coblation-assisted pediatric endoscopic skull base surgery.
- To compare the efficacy and safety of coblation versus traditional techniques in pediatric skull base surgery.
Main Methods:
- Retrospective review of medical records for patients under 15 years old undergoing endoscopic skull base surgery.
- Utilized estimated blood loss/operating time (EBL/OT) and Wormald grade for intraoperative blood loss assessment.
- Coblation was applied in 20 patients for various surgical tasks including tissue ablation and tumor excision.
Main Results:
- Coblation use was associated with a significant decrease in EBL/OT (34.1 vs 56.3 ml/h, p=0.048) and Wormald grade (5.7 vs 6.9, p=0.038) compared to traditional methods.
- The study included 28 pediatric patients with diagnoses such as juvenile nasopharyngeal angiofibroma, CSF leaks, and sinonasal neoplasms.
- No significant difference in postoperative complications, including cranial nerve dysfunction and CSF rhinorrhea, was observed during the follow-up period.
Conclusions:
- Coblation is a safe and effective instrument for pediatric skull base surgery.
- Coblation-assisted surgery demonstrates improved intraoperative hemostasis and reduced operating time in pediatric patients.
- The technique shows promise for enhancing outcomes in complex pediatric skull base procedures.
Background:
Pediatric skull base surgeries are confined by developmental and anatomical issues. Radiofrequency coblation integrates the functions of ablation, suction, and coagulation with the ability to dissolve tissues with limited thermal injury, making it an ideal instrument for pediatric skull base surgery. We sought to evaluated the clinical outcomes of coblation-assisted pediatric endoscopic skull base surgery.
Methods:
Medical records of patients under 15 years of age undergoing endoscopic skull base surgery were retrospectively reviewed. The estimated blood loss (EBL)/operating time (OT) and Wormald grade were used for intraoperative blood loss grading.
Results:
Generally, 28 patients (17 males, 11 females) with an average age of 8.4 ± 4.2 years, (range, 11 months to 15 years old) were included. Coblation was applied in 20 patients for mucosa coagulation and handling, cartilage removal, tumor separation and excision. The primary diagnoses included juvenile nasopharyngeal angiofibroma (n = 5), traumatic cerebrospinal fluid (CSF) leak (n = 6), congenital meningoencephalocele (n = 6) and miscellaneous sinonasal and skull base neoplasm (n = 11). The application of coblation was related with a significant decrease in EBL/OT (34.1 ± 17.5 vs 56.3 ± 22.6 ml/h, p = 0.048) and Wormald grade (5.7 ± 1.5 vs 6.9 ± 2.0, p = 0.038), compared with the traditional techniques. All surgical procedures were uneventful. No significant difference in postoperative complications, including cranial nerve dysfunction and CSF rhinorrhea were documented during the follow-up period (average, 34.7 ± 4.4 months).
Conclusion:
We suggested the coblation be a safe and effective instrument for pediatric skull base surgery.
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