Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Int J Pediatr Otorhinolaryngol. 2022 Nov;162:111332. doi: 10.1016/j.ijporl.2022.111332. Epub 2022 Oct 2.
Endoscopic endonasal approaches to pediatric skull base lesions are rare, challenging, and present distinct considerations from adult pathology. In this study, we describe our endoscopic technical approach to various skull base lesions demonstrating the efficacy and nuances of these approaches in pediatric patients.
Pediatric patients underwent endoscopic approach for skull base lesions from January of 2015 to April of 2021 were included in the study. Presenting symptoms, indications for surgery, surgical outcomes, intraoperative and postoperative complications, length of hospital stay, and length of follow-up were documented.
A total of 18 patients (median age 12, age-range 1-15, 53% male) underwent 19 endoscopic transsphenoidal procedures. The pathologies included craniopharyngioma (N = 5), biopsy for an unknown disease (n = 2; orbital meningioma and pituitary lymphocytic hypophysitis), pituitary adenoma (N = 2; ACTH-secreting and non-functional), Rathke's cleft cyst (n = 2), CSF leak repairs (n = 2; post-traumatic and spontaneous meningocele), juvenile nasopharyngeal angiofibroma (n = 3, 1 patient had 2 procedures) and rhabdomyosarcoma (n = 1). GTR was achieved in 11 out of 15 procedures (73.3%). Out of 10 patients with a sellar lesion, 6 patients had intraoperative CSF leak (60%). No patients experienced post-operative CSF leak. The median follow-up for all patients was 14 months (1-36 months).
Anterior and middle skull base pathology in pediatric patients can be effectively operated via an endoscopic approach across a wide variety of patient ages and conditions. Minimally invasive techniques with middle turbinate and nasal septum preservation can be achieved without compromising outcomes. A wide variety of surgical repair strategies can be successfully utilized.
儿童颅底病变的内镜经鼻入路较为少见，具有挑战性，且与成人病变有明显不同。本研究描述了我们对各种颅底病变的内镜技术方法，展示了这些方法在儿科患者中的疗效和细微差别。
纳入了 2015 年 1 月至 2021 年 4 月期间接受内镜颅底病变治疗的儿科患者。记录了患者的主要症状、手术指征、手术结果、术中及术后并发症、住院时间和随访时间。
共 18 例患者（中位年龄 12 岁，年龄范围 1-15 岁，53%为男性）接受了 19 例内镜经蝶窦入路手术。病变包括颅咽管瘤（n=5）、不明原因疾病活检（2 例；眶内脑膜瘤和垂体淋巴细胞性垂体炎）、垂体腺瘤（2 例；ACTH 分泌型和无功能型）、 Rathke 裂囊肿（n=2）、脑脊液漏修复（2 例；创伤后和自发性脑脊膜膨出）、青少年鼻咽血管纤维瘤（n=3，1 例患者接受了 2 次手术）和横纹肌肉瘤（n=1）。15 例手术中有 11 例（73.3%）达到全切。10 例鞍区病变患者中，6 例（60%）术中发生脑脊液漏。无患者发生术后脑脊液漏。所有患者的中位随访时间为 14 个月（1-36 个月）。
通过内镜入路，可有效治疗儿童患者的前、中颅底病变，患者年龄和病情差异较大。通过保留中鼻甲和鼻中隔的微创技术，可以在不影响疗效的情况下实现。可以成功地采用多种手术修复策略。
