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CSF leak after pediatric endoscopic endonasal expanded approaches: a series review
Pablo Miranda-Lloret1, Juan Antonio Simal-Julian2, Laila Pérez de San Román-Mena2
1Pediatric Neurosurgery, Hospital Universitari I Politècnica La Fe, 46010, Valencia, Spain. Miranda_pab@gva.es.
Insights
Pediatric endoscopic endonasal approaches have a higher risk of cerebrospinal fluid (CSF) leaks compared to adults. Extended approaches and specific sinus anatomy increase this risk, necessitating careful multilayer closure.
Area of Science:
- Neurosurgery
- Otolaryngology
- Pediatric Surgery
Background:
- Endoscopic endonasal approaches (EEA) are increasingly utilized in pediatric neurosurgery.
- Managing postoperative cerebrospinal fluid (CSF) leaks is a significant challenge in pediatric EEA.
- Understanding the incidence and risk factors for CSF leaks in children is crucial.
Purpose of the Study:
- To determine the incidence of postoperative CSF leaks in pediatric patients undergoing EEA.
- To analyze factors associated with CSF leaks in this specific population.
Main Methods:
- Retrospective analysis of an institutional series of pediatric patients.
- Case review and descriptive statistical analysis.
- Bivariate correlation analysis to identify risk factors.
Main Results:
- Four out of twenty-one pediatric patients (19%) experienced postoperative CSF leaks requiring revision surgery.
- EEA extending beyond the sellar area were associated with a higher risk of CSF leak.
- Non-sellar pneumatization of the sphenoid sinus also correlated with an increased risk of CSF leak.
Conclusions:
- The incidence of CSF leaks following pediatric EEA is higher than reported in adult series.
- Pediatric patients present unique anatomical and pathological complexities that increase surgical risks.
- Multilayer closure techniques are recommended for preventing and managing CSF leaks in pediatric EEA.
Purpose:
Endoscopic endonasal approaches in the pediatric population pose specific challenges. Management of postoperative cerebrospinal fluid [CSF] leak is probably the major concern. The purpose of the present investigation is to describe and analyze the incidence of postoperative CSF leaks in our pediatric series of endoscopic endonasal approaches.
Methods:
This is a retrospective analysis, case review of our institutional series. Descriptive statistical parameters and bivariate correlations are analyzed.
Results:
Twenty-one patients have been operated through endoscopic approaches in our series. Four patients showed a postoperative CSF leak needing a revision surgery; these cases are described in further detail. Approaches expanded beyond the sellar area and non-sellar pneumatization of the sphenoid sinus were significantly associated with a higher risk of postoperative CSF leak.
Conclusions:
CSF leak incidence after endoscopic endonasal approaches is higher in pediatric patients than in adult series. Anatomic and pathologic factors add complexity to these approaches in children. Multilayer closure is advisable to prevent and treat this complication.
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