University of California San Diego School of Medicine, La Jolla, California, USA.
Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA.
Pediatr Neurosurg. 2021;56(4):345-356. doi: 10.1159/000516236. Epub 2021 May 19.
The purpose of this study is to use imaging data to determine if endoscopic endonasal surgery (EES) for skull base tumor resection interrupts skull base growth and development, resulting in an atrophic midface skeletal structure, compared to matched normal controls.
Data were collected by a retrospective chart review done on children aged 16 years and below who underwent endoscopic tumor resection and had pre- and postoperative magnetic resonance imaging with relevant midface anatomy. 121 normal controls were matched to 20 EES patients by age and gender. Three measurements related to midface anatomy were taken from 1 sagittal T1 slice and 1 axial T2 slice of each scan. Statistical analysis was used to compare growth measures between cases and controls.
Twenty patients who underwent EES between November 2015 and April 2018 met our inclusion criteria. The mean age of the patients, 11 males and 9 females, was 10 years, and 8 patients (38%) were aged 7 years or younger. Six patients who had a high-flow CSF leak obtained a nasoseptal flap. A student T test and multivariate regression analysis found that EES did not affect midface and skull base growth. Among the variables assessed, age appears to be the only driver of growth.
There were no identified differences in craniofacial growth in pediatric patients undergoing EES for skull base tumor resection as compared to the control group. EES does not appear to significantly interfere with midface/skull base development and is a good surgical option for pediatric patients.
本研究旨在利用影像学数据确定内镜经鼻颅底手术（EES）切除颅底肿瘤是否会中断颅底生长和发育，导致中面部骨骼结构萎缩，与匹配的正常对照组相比。
通过对 2015 年 11 月至 2018 年 4 月期间接受内镜肿瘤切除术且具有相关中面部解剖结构的术前和术后磁共振成像的 16 岁及以下儿童进行回顾性图表审查来收集数据。通过年龄和性别匹配了 121 例正常对照组和 20 例 EES 患者。从每个扫描的 1 个矢状 T1 切片和 1 个轴向 T2 切片中获取 3 个与中面部解剖结构相关的测量值。使用统计分析比较病例组和对照组的生长指标。
符合纳入标准的 20 名接受 EES 的患者中，男性 11 名，女性 9 名，平均年龄为 10 岁，8 名（38%）患者年龄在 7 岁或以下。6 名有高流量脑脊液漏的患者获得了鼻中隔瓣。学生 t 检验和多元回归分析发现 EES 不会影响中面部和颅底的生长。在评估的变量中，年龄似乎是唯一的生长驱动因素。
与对照组相比，接受 EES 切除颅底肿瘤的儿科患者的颅面生长没有差异。EES 似乎不会显著干扰中面部/颅底发育，是儿科患者的良好手术选择。
