LoPresti Melissa A, Sellin Jonathan N, DeMonte Franco
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States.
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
J Neurol Surg B Skull Base. 2018 Feb;79(1):3-12. doi: 10.1055/s-0037-1617449. Epub 2018 Jan 5.
To review developmental surgical anatomy and technical nuances related to pediatric skull base surgery. Retrospective, single-center case series with literature review. MD Anderson Cancer Center. Patients undergoing pediatric skull base surgery. Review developmental anatomy of the pediatric skull base as it relates to technical nuance of various surgical approaches and insight gained from a 25-year institutional experience with this unique patient population. Thirty-nine patients meeting these criteria were identified over a 13-year period from 2003 to 2016 and compared to a previously reported earlier cohort from 1992 to 2002. The most common benign pathologies included nerve sheath tumors (11%), juvenile nasopharyngeal angiofibromas (9.5%), and craniopharyngiomas (4.8%). The most common malignancies were chondrosarcoma (11%), chordoma (11%), and rabdomyosarcoma (11%). Varied surgical approaches were utilized and were similar between the two cohorts save for the increased use of endoscopic surgical techniques in the most recent cohort. The most common sites of tumor origin were the infratemporal fossa, sinonasal cavities, clivus, temporal bone, and parasellar region. Gross total resection and postoperative complication rates were similar between the two patient cohorts. Pediatric skull base tumors, while rare, often are treated surgically, necessitating an in depth understanding of the anatomy of the developing skull base.
回顾与小儿颅底手术相关的发育性手术解剖结构及技术细节。 回顾性单中心病例系列研究并进行文献综述。 德克萨斯大学MD安德森癌症中心。 接受小儿颅底手术的患者。 回顾小儿颅底的发育解剖结构，及其与各种手术入路技术细节的关系，以及从对这一独特患者群体长达25年的机构经验中获得的见解。 在2003年至2016年的13年期间，共确定了39例符合这些标准的患者，并与之前报道的1992年至2002年的早期队列进行了比较。最常见的良性病变包括神经鞘瘤（11%）、青少年鼻咽血管纤维瘤（9.5%）和颅咽管瘤（4.8%）。最常见的恶性肿瘤是软骨肉瘤（11%）、脊索瘤（11%）和横纹肌肉瘤（11%）。采用了多种手术入路，除了最近队列中内镜手术技术的使用增加外，两个队列之间的手术入路相似。肿瘤最常见的起源部位是颞下窝、鼻窦腔、斜坡、颞骨和鞍旁区域。两个患者队列的大体全切除率和术后并发症发生率相似。 小儿颅底肿瘤虽然罕见，但通常需要手术治疗，因此有必要深入了解发育中的颅底解剖结构。
