Banu Matei A, Guerrero-Maldonado Amancio, McCrea Heather J, Garcia-Navarro Victor, Souweidane Mark M, Anand Vijay K, Heier Linda, Schwartz Theodore H, Greenfield Jeffrey P
Departments of Neurological Surgery.
J Neurosurg Pediatr. 2014 Feb;13(2):155-69. doi: 10.3171/2013.10.PEDS13303. Epub 2013 Dec 6.
Scarce morphometric data exist on the developing skull base as a corridor for endonasal endoscopic approaches (EEAs). Furthermore, the impact of skull base lesions on its development has not been assessed. The authors describe a novel set of anatomical parameters characterizing the developmental process as well as the utility of these parameters in preoperative planning and a feasibility assessment of EEAs for neurosurgical treatment of skull base lesions in children.
Based on specific MRI sequences in 107 pediatric patients (2-16 years of age) without skull base lesions (referred to here as the normal population), 3 sets of anatomical parameters were analyzed according to age group and sex: drilling distance, restriction sites, and working distance parameters. A separate set of patients undergoing EEAs was analyzed in similar fashion to address the impact of skull base lesions on the developmental process.
The volume of the sphenoid sinus significantly increases with age, reaching 6866.4 mm(3) in the 14-16 years age group, and directly correlates with the pneumatization type (r = 0.533, p = 0.0001). The pneumatization process progresses slowly in a temporal-posterior direction, as demonstrated by the growth trend of the sellar width (r = 0.428, p = 0.0001). Nasal restriction sites do not change significantly with age, with little impact on EEAs. The intercarotid distance is significantly different only in the extreme age groups (3.9 mm, p = 0.038), and has an important impact on the transsphenoidal angle and the intracranial dissection limits (r = 0.443, p < 0.0001). The 14.9° transsphenoidal angle at 2-4 years has a 37.6% significant increase in the 11-13 years age group (p = 0.001) and is highly dependent on pneumatization type. Age-dependent differences between working parameters are mostly noted for the extreme age groups, such as the 8.6-mm increase in nare-vomer distance (p = 0.025). The nare-sellar distance is the only parameter with significant differences based on sex. Skull base lesions induce a high degree of variance in skull base measurements, delaying development and decreasing parameter values. Skull base parameters are interdependent. Nare-sellar distance can be used to assess global skull base development because it highly correlates with the intercarotid distance in both the normal population and in patients harboring skull base lesions.
Skull base development is a slow, gradual, age-dependent, sex-independent process significantly altering endonasal endoscopic corridors. Preoperative MRI measurements of the pediatric skull base are thus a useful adjunct in choosing the appropriate corridor and in assessing working angles and limits during dissection or reparative surgery. Skull base lesions can significantly impact normal skull base development and age-dependent growth patterns.
作为鼻内镜手术入路的通道，发育中的颅底的形态测量数据稀缺。此外，颅底病变对其发育的影响尚未得到评估。作者描述了一组新的解剖学参数，这些参数表征了发育过程，以及这些参数在术前规划中的实用性和对儿童颅底病变神经外科治疗鼻内镜手术入路可行性评估的作用。
基于107例无颅底病变的儿科患者（2至16岁，以下称为正常人群）的特定MRI序列，根据年龄组和性别分析了3组解剖学参数：钻孔距离、限制部位和工作距离参数。以类似方式分析了另一组接受鼻内镜手术的患者，以探讨颅底病变对发育过程的影响。
蝶窦体积随年龄显著增加，在14至16岁年龄组达到6866.4立方毫米，且与气化类型直接相关（r = 0.533，p = 0.0001）。如鞍底宽度的增长趋势所示（r = 0.428，p = 0.0001），气化过程在颞后方向进展缓慢。鼻限制部位随年龄变化不显著，对鼻内镜手术入路影响较小。颈内动脉间距仅在极端年龄组有显著差异（3.9毫米，p = 0.038），且对经蝶角度和颅内解剖界限有重要影响（r = 0.443，p < 0.0001）。2至4岁时14.9°的经蝶角度在11至13岁年龄组显著增加37.6%（p = 0.001），且高度依赖于气化类型。工作参数的年龄依赖性差异主要见于极端年龄组，如鼻孔-犁骨距离增加8.6毫米（p = 0.025）。鼻孔-鞍底距离是唯一基于性别的有显著差异的参数。颅底病变导致颅底测量的高度变异，延迟发育并降低参数值。颅底参数相互依赖。鼻孔-鞍底距离可用于评估整体颅底发育，因为它在正常人群和患有颅底病变的患者中均与颈内动脉间距高度相关。
颅底发育是一个缓慢、渐进、依赖年龄、不依赖性别的过程，显著改变鼻内镜手术通道。因此，小儿颅底的术前MRI测量在选择合适的通道以及评估解剖或修复手术期间的工作角度和界限方面是有用的辅助手段。颅底病变可显著影响正常颅底发育和依赖年龄的生长模式。
