Nation Javan, Schupper Alexander J, Deconde Adam, Levy Michael
Department of Surgery, Division of Otolaryngology, Head and Neck Surgery University of California San Diego, Division of Pediatric Rady Children's Hospital San Diego, USA; University of California San Diego School of Medicine, La Jolla, CA, USA.
Department of Neurosurgery, University of California San Diego, Division of Pediatric Neurosurgery Rady Children's Hospital San Diego, USA; University of California San Diego School of Medicine, La Jolla, CA, USA.
Int J Pediatr Otorhinolaryngol. 2019 Apr;119:22-26. doi: 10.1016/j.ijporl.2019.01.010. Epub 2019 Jan 11.
The endoscopic expanded endonasal approach (EEA) has been shown to be a safe and effective surgical technique in the resection of pediatric skull base lesions. Cerebrospinal fluid (CSF) leaks are among the most common complications of this approach. Here we review skull base resections using EEA in pediatric patients at our single institution, to identify potential risk factors for this surgical complication.
A retrospective chart review was conducted on pediatric patients at our single institution for patients 19 years-old and under, who underwent an EEA for resection of a skull base tumor.
Thirty-nine pediatric patients (ages 1-19 years) with 8 different tumor pathologies underwent an EEA for resection of their skull base tumors. 21 patients experienced an intraoperative CSF leak, of which 10 (48%) were "high-flow" leaks and 11 (52%) were "low-flow" leaks. Nasoseptal flaps were only used to repair the intraoperative "high flow" leaks (n = 10), and "low flow" and "no leaks" were repaired with allograft and fat. No patients experienced a post-operative CSF leak.
In our pediatric series, the skull base repair algorithm of using an NSF only in cases of "high flow" intraoperative leaks was effective, and no post-operative CSF leaks occurred. Not using an NSF in cases of "low-flow" or "no leak" cases allows for decreased anatomical disruption in the growing patient.
内镜扩大经鼻入路（EEA）已被证明是一种安全有效的手术技术，可用于切除小儿颅底病变。脑脊液（CSF）漏是该入路最常见的并发症之一。在此，我们回顾了在我们单一机构中对小儿患者采用EEA进行的颅底切除术，以确定这种手术并发症的潜在危险因素。
对我们单一机构中19岁及以下接受EEA切除颅底肿瘤的小儿患者进行回顾性病历审查。
39例患有8种不同肿瘤病理类型的小儿患者（年龄1 - 19岁）接受了EEA切除颅底肿瘤手术。21例患者术中出现脑脊液漏，其中10例（48%）为“高流量”漏，11例（52%）为“低流量”漏。鼻中隔瓣仅用于修复术中“高流量”漏（n = 10），“低流量”漏和“无漏”则用同种异体移植物和脂肪修复。没有患者出现术后脑脊液漏。
在我们的小儿系列研究中，仅在术中“高流量”漏的情况下使用鼻中隔瓣的颅底修复方案是有效的，且未发生术后脑脊液漏。在“低流量”或“无漏”的情况下不使用鼻中隔瓣可减少对生长中患者的解剖结构破坏。
