Reconstruction of pediatric skull base defects: A retrospective analysis emphasizing the very young

Nyall R London Jr; Gustavo G Rangel; Amanda Onwuka; Ricardo L Carrau; Daniel M Prevedello; Jeffrey A Leonard; Patrick C Walz

doi:10.1016/j.ijporl.2020.109962

Reconstruction of pediatric skull base defects: A retrospective analysis emphasizing the very young

Int J Pediatr Otorhinolaryngol. 2020 Jun:133:109962. doi: 10.1016/j.ijporl.2020.109962. Epub 2020 Feb 19.

Authors

Nyall R London Jr¹, Gustavo G Rangel², Amanda Onwuka³, Ricardo L Carrau⁴, Daniel M Prevedello⁴, Jeffrey A Leonard⁵, Patrick C Walz⁶

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA; Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD, USA.
² Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
³ Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA.
⁴ Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA.
⁵ Department of Neurological Surgery, The Ohio State University, Columbus, OH, USA; Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.
⁶ Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: Patrick.Walz@nationwidechildrens.org.

PMID: 32109673
DOI: 10.1016/j.ijporl.2020.109962

Abstract

Introduction: Pathology of the pediatric skull base is rare and ranges from congenital defects to malignancy and traumatic defects. Pediatric patients, particularly those ≤6 years of age, present a unique set of anatomic challenges for the skull base surgeon. The goal of this study was to retrospectively review our experience with reconstruction of pediatric skull base defects with particular emphasis on those ≤6 years of age.

Methods: A retrospective chart review was conducted of patients ≤20 years of age who underwent endoscopic endonasal and combined endoscopic and open approaches to address cranial base pathology from 2007 to 2018. Patients were divided into two groups; those ≤6 years of age (group A) and those >6 years of age and ≤20 years of age (group B) and reconstructive techniques and outcomes were analyzed.

Results: Intraoperative communication with the subarachnoid space (CSF leak) was created in 50% (3/6) of patients ≤ 6 years of age compared to 32.7% (16/49) in patients > 6 years and ≤20 years of age (P < 0.40) in management of their skull base disease. A vascularized flap was utilized for reconstruction in 66.7% (4/6) of patients ≤ 6 years of age and included a nasoseptal flap in 33.3% (2/6). A vascularized flap was utilized for reconstruction in 38.8% (19/49) of patients > 6 years and ≤20 years of age and most commonly included a nasoseptal flap (22.4%, 11/49). A lumbar drain was utilized in 50% (3/6) of patients ≤ 6 years of age compared to 18.4% (9/49) in patients > 6 and ≤20 years of age (P < 0.08). Post-operative CSF leaks were encountered in 16.7% (1/6) of patients ≤ 6 years of age compared to 10.2% (5/49) in patients > 6 and ≤20 years of age (P < 0.63). Behavioral issues were noted to potentially contribute to failed skull base reconstruction in patients <6 years of age.

Conclusions: Pediatric patients, particularly those ≤6 years of age, present a unique set of anatomic and behavioral challenges for the skull base surgeon as highlighted in this study.

Keywords: Cerebrospinal fluid leak; Pediatric skull base surgery; Skull base reconstruction.

MeSH terms

Adolescent
Adult
Age Factors
Child
Child, Preschool
Endoscopy / methods
Female
Humans
Infant
Infant, Newborn
Male
Outcome Assessment, Health Care
Plastic Surgery Procedures / methods*
Postoperative Complications / epidemiology
Retrospective Studies
Skull Base / surgery*
Surgical Flaps / transplantation
Young Adult