Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Laryngoscope. 2021 May;131(5):996-1001. doi: 10.1002/lary.29127. Epub 2020 Nov 2.
OBJECTIVE/HYPOTHESIS: To characterize the pathology and outcomes of skull base surgery in the pediatric population by open versus endoscopic surgical approach.
Retrospective cohort study.
A retrospective review of pediatric patients (<18 years) who underwent skull base surgery for nonmalignant disease from May 2000 to August 2019 was performed. Patient demographics, pathology, and operative characteristics by surgical approach were recorded and analyzed. Patients with a combined endoscopic/open approach were classified as open for the analysis.
Eighty-two pediatric skull base patients were identified with a mean age of 11.3 years (standard deviation 5.2). A purely endoscopic approach was used in 63 (77%) patients, a purely open approach was used in nine (11%) patients, and a combined open/endoscopic approach was used in 10 (12%) patients. The all-cause complication rate was 9.8%. There was no statistically significant difference in rate of complications between patients with an open versus endoscopic approach for resection (15.8% vs. 7.9%; P = .379). Risk of having a complication did not significantly vary by patient age. The odds of having a complication with an open approach was not statistically significant in a multivariable model adjusted for age, sex, race, intraoperative cerebrospinal fluid leak, tracheostomy requirement, and vascular flap use (odds ratio 2.76, 95% confidence interval 0.28-26.94; P = .383).
Our retrospective study demonstrates a similar risk of complication for open versus endoscopic approach to resection in pediatric skull base patients at our institution. Safety and feasibility of the endoscopic approach has previously been demonstrated in children, and this is the first study to directly compare outcomes with open approaches.
4 Laryngoscope, 131:996-1001, 2021.
目的/假设：通过开颅和内镜手术方法，对儿童颅底手术的病理学和结果进行特征描述。
回顾性队列研究。
对 2000 年 5 月至 2019 年 8 月期间因非恶性疾病接受颅底手术的小儿（<18 岁）患者进行了回顾性审查。记录并分析了患者的人口统计学、病理学和手术特征，以及手术方法。采用联合内镜/开颅手术的患者被归类为开颅分析。
共确定了 82 例小儿颅底患者，平均年龄为 11.3 岁（标准差为 5.2）。63 例（77%）患者采用纯内镜方法，9 例（11%）患者采用纯开颅方法，10 例（12%）患者采用联合开颅/内镜方法。总并发症发生率为 9.8%。内镜组与开颅组在切除时的并发症发生率之间没有统计学差异（15.8%比 7.9%；P =.379）。并发症风险不因患者年龄而有显著差异。在调整了患者年龄、性别、种族、术中脑脊液漏、气管切开术需求和血管皮瓣使用的多变量模型中，开颅组发生并发症的几率无统计学意义（比值比 2.76，95%置信区间 0.28-26.94；P =.383）。
本回顾性研究表明，在我们机构中，儿童颅底患者采用开颅与内镜切除方法的并发症风险相似。内镜方法的安全性和可行性在儿童中已得到证实，这是第一项直接比较与开颅方法结果的研究。
4 级《喉镜》，131：996-1001，2021。
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