Chen Joshua, Pool Christopher, Slonimsky Einat, King Tonya S, Pradhan Sandeep, Wilson Meghan N
Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States.
Department of Radiology, Penn State Hershey Medical Center, Hershey, Pennsylvania United States.
J Neurol Surg B Skull Base. 2022 Jul 5;84(4):336-348. doi: 10.1055/a-1862-0321. eCollection 2023 Aug.
Endoscopic endonasal anterior skull base surgery has expanding use in the pediatric population, but the anatomy of pediatric patients can lead to limitations. This study aims to characterize the important anatomical implications of the pediatric skull base using computed tomography (CT) scans. This study is designed as retrospective analysis. The study setting comprises of tertiary academic medical center. In total, 506 patients aged 0 to 18 who had undergone maxillofacial and or head CTs between 2009 to 2016 were involved. Measurements included piriform aperture width, nare to sella distance (NSD), sphenoid pneumatization, olfactory fossa depth, lateral lamella cribriform plate angles, and intercarotid distances (ICD) at the superior clivus and cavernous sinus. These patients were then subdivided into three age groups adjusting for sex. Analysis of covariance (ANCOVA) models were fit comparing between all age groups and by sex. Piriform aperture width, NSD, sphenoid sinus pneumatization as measured using lateral aeration and anterior sellar wall thickness, olfactory fossa depth, and ICD at the cavernous sinus were significantly different among all age groups ( <0.0001). Our results show that mean piriform aperture width increased with each age group. The mean olfactory fossa depth also had consistent age dependent growth. In addition, ICD at the cavernous sinus showed age dependent changes. When comparing by sexes, females consistently showed smaller measurements. The process of skull base development is age and sex dependent. During preoperative evaluation of pediatric patients for skull base surgery piriform aperture width, sphenoid pneumatization in both the anterior posterior and lateral directions, and ICD at the cavernous sinus should be carefully reviewed.
鼻内镜下经鼻前颅底手术在儿科人群中的应用日益广泛，但儿科患者的解剖结构可能会带来一些限制。本研究旨在通过计算机断层扫描（CT）来描述小儿颅底的重要解剖学特征。
本研究设计为回顾性分析。
研究地点为三级学术医疗中心。
共有506例年龄在0至18岁之间的患者参与，这些患者在2009年至2016年间接受了颌面和/或头部CT扫描。
测量指标包括梨状孔宽度、鼻孔至蝶鞍距离（NSD）、蝶窦气化、嗅窝深度、筛板外侧板角度以及斜坡上部和海绵窦处的颈内动脉间距（ICD）。然后根据性别将这些患者分为三个年龄组。采用协方差分析（ANCOVA）模型对所有年龄组之间以及按性别进行比较。
所有年龄组之间，梨状孔宽度、NSD、用外侧通气和蝶鞍前壁厚度测量的蝶窦气化、嗅窝深度以及海绵窦处的ICD均有显著差异（<0.0001）。我们的结果显示，平均梨状孔宽度随年龄组的增加而增加。平均嗅窝深度也呈现出与年龄相关的一致增长。此外，海绵窦处的ICD显示出与年龄相关的变化。按性别比较时，女性的测量值始终较小。
颅底发育过程与年龄和性别有关。在对小儿患者进行颅底手术的术前评估时，应仔细检查梨状孔宽度、前后及外侧方向的蝶窦气化以及海绵窦处的ICD。
