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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Early Initiation of Adjuvant Therapy Following Pediatric Endoscopic Endonasal Surgery for Tumors
Heta Patel1, Alan D Workman2, David K Lerner3
1Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA.
Insights
Early adjuvant therapy, including radiation and chemotherapy, is safe for pediatric skull base tumor patients after endoscopic endonasal resection. This approach did not increase complications, supporting its use in this population.
Area of Science:
- Pediatric Neurosurgery
- Skull Base Surgery
- Endoscopic Endonasal Surgery
Background:
- Skull base tumors in children often require complex surgical resection.
- Adjuvant therapy (radiation and/or chemotherapy) may be necessary post-surgery.
- The optimal timing for initiating adjuvant therapy after endoscopic endonasal resection is not well-established.
Purpose of the Study:
- To evaluate the complication rates associated with early adjuvant therapy initiation in pediatric patients undergoing endoscopic endonasal resection for skull base tumors.
Main Methods:
- Retrospective case series of pediatric patients (0-18 years) treated between 2013-2023.
- Included patients who received radiation within 3 months and/or chemotherapy within 2 weeks of surgery.
- Assessed perioperative and adjuvant therapy-related complications, including reconstruction failure, recurrence, and overall survival.
Main Results:
- 16 pediatric patients received early adjuvant therapy (radiation, chemotherapy, or chemoradiation).
- No cerebrospinal fluid (CSF) leaks occurred postoperatively or during adjuvant therapy.
- High dural reconstruction rate (93.8%) with common methods including nasoseptal flap.
Conclusions:
- Early adjuvant therapy initiation following endoscopic endonasal resection in pediatric skull base tumor patients did not result in significant complications.
- This approach demonstrates preliminary support for the safety of early adjuvant treatment in this population.
- Despite early initiation (radiation by postoperative day 1, chemotherapy by postoperative day 0), outcomes were favorable.
Objective:
To evaluate complication rates of early adjuvant therapy initiation in pediatric patients with endoscopic endonasal resection for skull base tumors.
Design:
Retrospective case series of pediatric patients (0-18 years old) with skull base tumors who underwent endoscopic endonasal resection between 2013 and 2023. The median follow-up was 4.21 years.
Setting:
Single, urban academic pediatric center.
Participants:
Patients who received radiation within 3 months and/or chemotherapy within 2 weeks of endoscopic endonasal resection.
Main Outcome Measures:
Primary outcomes were perioperative and adjuvant therapy-related complications including reconstruction failure. Secondary outcomes were recurrence and overall survival.
Results:
This study included 16 patients (radiation [n = 10]; chemoradiation [n = 2]; chemotherapy [n = 4]) with a variety of tumor types and high dural reconstruction rate (93.8%, n = 15). The average time to radiation was 39 days. The average time to chemotherapy was 9.5 days. The most common reconstructive method included nasoseptal flap and nasoseptal flap plus fat/tensor fascia lata. No patients in either group experienced cerebrospinal fluid (CSF) leaks postoperatively or during adjuvant therapy. Only one patient experienced a recurrence post-resection, and overall survival at the median follow-up time was 91%.
Conclusions:
A majority of our patient cohort experienced intraoperative CSF leaks resulting in a high rate of complex endonasal reconstructions. Adjuvant treatment postoperatively did not incur significant complications, despite initiation of radiation as early as postoperative day 1 or chemotherapy as early as postoperative day 0, demonstrating preliminary support of the safety of early adjuvant therapy initiation following endoscopic endonasal procedures in the pediatric skull base tumor population.
