Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA.
Otolaryngol Head Neck Surg. 2020 Aug;163(2):284-292. doi: 10.1177/0194599820913637. Epub 2020 Mar 24.
The advent of endonasal endoscopic skull base surgery (ESBS) has redefined the management of pediatric sellar and suprasellar lesions. To date, the outcomes of these procedures have not been systematically reviewed. This study performed a systematic review with meta-analysis of surgical outcomes for pediatric patients undergoing ESBS for sellar and suprasellar lesions.
PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane Library (Wiley).
Articles reporting on pediatric patients undergoing ESBS for craniopharyngiomas, pituitary adenomas, and Rathke's cleft cysts were reviewed. The primary outcome was postoperative cerebrospinal fluid (CSF) leak. Secondary outcomes included endocrine, visual, and other complications.
Twenty-five articles reporting on 554 patients were included. Overall postoperative CSF leak rate was 8.6%, with tumor-specific rates of 10.6% in craniopharyngiomas, 6.5% in pituitary adenomas, and 7.2% in Rathke's cleft cysts ( > .05). Older studies demonstrate higher postoperative CSF leak rates as compared with more recent studies (12.5% vs 6.1%, = .0082). Younger children (8.9-12.6 years old) experienced a higher rate of postoperative CSF leaks as compared with older children (13.0-16.6 years old; 12.9% vs 4.9%, = .0016). Additional postoperative complications included diabetes insipidus (26.7%), hypopituitarism (46.6%), visual deficits (2.6%), meningitis (3.4%), and weight gain (3.4%).
ESBS for pediatric sellar and suprasellar lesions is overall an effective management approach with an increasingly favorable risk-benefit profile. Younger children may be more susceptible to postoperative CSF leak as compared with older pediatric patients. Tumor type does not appear to be an independent risk factor for postoperative CSF leak in this population.
经鼻内镜颅底手术（ESBS）的出现重新定义了儿童鞍区和鞍上病变的治疗方法。迄今为止，这些手术的结果尚未得到系统评价。本研究对经 ESBS 治疗儿童鞍区和鞍上病变的手术结果进行了系统评价和荟萃分析。
PubMed（美国国立卫生研究院国家医学图书馆）、Scopus（爱思唯尔）和 Cochrane Library（Wiley）。
回顾了报道儿童经 ESBS 治疗颅咽管瘤、垂体腺瘤和 Rathke 裂囊肿的文章。主要结果是术后脑脊液（CSF）漏。次要结果包括内分泌、视力和其他并发症。
共纳入 25 篇报道 554 例患者的文章。总体术后 CSF 漏发生率为 8.6%，颅咽管瘤、垂体腺瘤和 Rathke 裂囊肿的肿瘤特异性发生率分别为 10.6%、6.5%和 7.2%（>.05）。与较新的研究相比，较老的研究显示术后 CSF 漏发生率更高（12.5%比 6.1%， =.0082）。年龄较小的儿童（8.9-12.6 岁）比年龄较大的儿童（13.0-16.6 岁）术后 CSF 漏发生率更高（12.9%比 4.9%， =.0016）。其他术后并发症包括尿崩症（26.7%）、垂体功能减退（46.6%）、视力障碍（2.6%）、脑膜炎（3.4%）和体重增加（3.4%）。
经 ESBS 治疗儿童鞍区和鞍上病变总体上是一种有效的治疗方法，其风险效益比越来越有利。与年长的儿科患者相比，年龄较小的儿童可能更容易发生术后 CSF 漏。在该人群中，肿瘤类型似乎不是术后 CSF 漏的独立危险因素。
