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Updated: Aug 26, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Incidence of Sinus Inflammation After Endoscopic Skull Base Surgery in the Pediatric Population
Laura E Henry1, Jacob G Eide1, Rijul S Kshirsagar1
1Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Insights
Pediatric endoscopic skull base surgery can cause temporary sinus inflammation, as measured by the Lund-Mackay (LM) score. This radiographic inflammation typically resolves within two years, alleviating concerns about chronic rhinosinusitis.
Area of Science:
- Otolaryngology
- Pediatric Neurosurgery
- Radiology
Background:
- Extended endonasal approach is used for pediatric anterior skull base lesions.
- Unique post-operative challenges include patient compliance and smaller nasal airways.
- Radiographic inflammation incidence requires evaluation in this population.
Purpose of the Study:
- To evaluate the incidence of post-operative radiographic inflammation using the Lund-Mackay (LM) score.
- To assess the resolution of inflammation after endoscopic skull base surgery in children.
Main Methods:
- Retrospective review of 72 pediatric patients (2009-2021).
- Analysis of pre- and post-operative imaging (MRI) using the Lund-Mackay (LM) score.
- Statistical comparison of LM scores using ANOVA and Tukey tests.
Main Results:
- Significant differences in LM scores were observed between pre-operative, early post-operative, and late post-operative imaging.
- Early post-operative LM scores were significantly higher than pre-operative scores.
- No significant difference was found between pre-operative and most recent post-operative LM scores.
Conclusions:
- Transient radiographic sinus inflammation is common after pediatric endoscopic skull base surgery.
- Inflammation appears to resolve by approximately two years post-surgery.
- This suggests that chronic rhinosinusitis may not be a long-term complication.
Background:
The extended endonasal approach has been utilized in the resection of anterior skull base lesions in the pediatric population. There are unique challenges to these patients in the post-operative setting, including patient compliance with medical therapy and post-operative debridements, and a smaller nasal airway that may increase propensity toward scarring. Our objective for this study is to evaluate the incidence of post-operative radiographic inflammation in this patient population using the Lund-Mackay (LM) score.
Methods:
A single-center, retrospective review of pediatric patients undergoing endoscopic approach to the skull base between 2009 and 2021 was performed. Demographic and clinicopathologic data and pre- and post-operative imaging were analyzed. One-way ANOVA followed by Tukey multiple pairwise comparisons statistical tests were used to compare mean LM scores between groups.
Results:
Seventy-two patients (52 males, 20 females) were identified with a median follow-up of 27 months. All patients underwent an extended endonasal approach for resection of skull base lesions. The mean LM scores were compared between pre-operative MRI, first post-operative MRI > 30 days after surgery, and most recent post-operative MRI. One-way ANOVA was performed with significant differences noted between the groups (p < 0.001). Tukey multiple pairwise comparisons test was then performed and noted significant differences between the pre-operative and first post-operative LM (p < 0.0001) and the first post-operative and most recent LM (p < 0.0001). There was no significant difference noted between the pre-operative LM score and most recent LM score (p = 0.14).
Conclusion:
Despite concerns regarding possible subsequent development of chronic rhinosinusitis following endoscopic skull base surgery in pediatric patients, the current study suggests that transient radiographic evidence of sinus inflammation can be seen up to six months postoperatively, which appears to resolve by approximately two years after surgery.
Level Of Evidence:
4 Laryngoscope, 133:2014-2017, 2023.
