Abstract
Objective The purpose of this study is to specifically assess pediatric patients with nonpneumatized
sphenoid sinuses who have undergone transsphenoidal resections of skull base tumors
and assess the complications and outcomes.
Methods Data was collected by a retrospective chart review done on children ages 7 and under
who underwent endoscopic tumor resection and had a partially or completely nonpneumatized
sphenoid sinus on preoperative computed tomography imaging. Surgical data collected
included surgical corridor, gross total versus subtotal resection, repair method,
use of septal flap, intraoperative and postoperative cerebrospinal fluid leak, and
estimated blood loss.
Results Six patients were identified that fit our inclusion criteria who underwent surgery
between November 2015 and April 2018 (3 males, 3 females; average age = 4.28 years).
Tumor pathologies include three craniopharyngiomas, Rathke cleft cyst, meningocele,
and neuroblastoma. All cases involved varying percentages of sphenoid sinus pneumatization.
All cases except one craniopharyngioma and the neuroblastoma required removal of cancellous
bone to access pathology. Degree of sphenoid pneumatization tended to be greater with
age and resulted in less intraoperative bleeding. The two youngest patients with completely
nonpneumatized sphenoid sinuses lost 61.73 and 17.52% of their total blood volume
intraoperatively. Procedures were able to be adequately performed and pathology completely
addressed with minimal postoperative complications and no postoperative CSF leaks.
Conclusions Intraoperative challenges including hemorrhage are likely in nonpneumatized patients,
and thus surgeons should be prepared with adequate vascular access and blood products.
Hemorrhage and total blood volume loss are increased in the younger patients with
no sphenoid pneumatization. Despite the additional challenges, a nonpneumatized sphenoid
sinus is not a contraindication for an endoscopic resection in the pediatric population.
Keywords
transsphendoidal resection - nonpneumatized sphenoid sinus - skull base tumor - endoscopic
tumor resection
