Outcomes in Pediatric Endoscopic Skull Base Surgery: A Systematic Review

Abstract

Objectives The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study aims to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents aged 0 to 18 years.

Design A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000 to 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Final inclusion criteria included: case series with more than 10 patients with pediatric patients aged ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported.

Setting This study was conducted at a tertiary care medical center.

Participants Children/adolescents aged 0 to 18 years who underwent endoscopic skull base surgery were participated in this study.

Main Outcome Measures Patient demographics, pathology, reconstructive technique, intraoperative findings, intraoperative, and postoperative surgical complications were measured through this study.

Results Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients aged 0 to 18 years met inclusion criteria for final analysis. Seven of the 12 studies discussed a single pathology. The most common pathology was a skull base defect causing cerebrospinal fluid (CSF) leak. The majority of skull base repairs were made with free tissue grafts. The most common postoperative complication was CSF leak (n = 40). Twelve cases of meningitis occurred postoperatively with two of these episodes resulting in death.

Conclusion Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

Keywords

skull base surgery - endoscopic skull base surgery - pediatric - outcomes

Publikationsverlauf

Eingereicht: 03. Januar 2021

Angenommen: 14. Dezember 2021

Accepted Manuscript online:
21. Dezember 2021

Artikel online veröffentlicht:
16. Januar 2022

• References

• 1 Wilson M, Snyderman C. Endoscopic management of developmental anomalies of the skull base. J Neurol Surg B Skull Base 2018; 79 (01) 13-20
• 2 LoPresti MA, Sellin JN, DeMonte F. Developmental considerations in pediatric skull base surgery. J Neurol Surg B Skull Base 2018; 79 (01) 3-12
• 3 Gump WC. Endoscopic endonasal repair of congenital defects of the anterior skull base: developmental considerations and surgical outcomes. J Neurol Surg B Skull Base 2015; 76 (04) 291-295
• 4 Tatreau JR, Patel MR, Shah RN. et al. Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients. Laryngoscope 2010; 120 (09) 1730-1737
• 5 Wasserzug O, DeRowe A, Ringel B, Fishman G, Fliss DM. Open approaches to the anterior skull base in children: review of the literature. J Neurol Surg B Skull Base 2018; 79 (01) 42-46
• 6 Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC. Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 2013; 11 (03) 227-241
• 7 Patel VS, Thamboo A, Quon J. et al. Outcomes after endoscopic endonasal resection of craniopharyngiomas in the pediatric population. World Neurosurg 2017; 108: 6-14
• 8 Di Rocco F, Couloigner V, Dastoli P, Sainte-Rose C, Zerah M, Roger G. Treatment of anterior skull base defects by a transnasal endoscopic approach in children. J Neurosurg Pediatr 2010; 6 (05) 459-463
• 9 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6 (07) e1000100
• 10 Oxford Centre for Evidence-Based Medicine: Levels of Evidence. Accessed December 30, 2021 at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009
• 11 Gupta AK, Gupta AK, Verma M. Cranionasal fistula in pediatric population: is endonasal endoscopic approach effective?. Int J Pediatr Otorhinolaryngol 2007; 71 (10) 1537-1541
• 12 Peng A, Li Y, Xiao Z, Wu W. Exploration of endonasal endoscopic repair of pediatric cerebrospinal fluid rhinorrhea. Int J Pediatr Otorhinolaryngol 2011; 75 (03) 308-315
• 13 Ibrahim AA, Magdy EA, Eid M. Endoscopic endonasal multilayer repair of traumatic ethmoidal roof cerebrospinal fluid rhinorrhea in children. Int J Pediatr Otorhinolaryngol 2012; 76 (04) 523-529
• 14 Emanuelli E, Bossolesi P, Borsetto D, D'Avella E. Endoscopic repair of cerebrospinal fluid leak in paediatric patients. Int J Pediatr Otorhinolaryngol 2014; 78 (11) 1898-1902
• 15 Locatelli D, Massimi L, Rigante M. et al. Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 2010; 74 (11) 1298-1302
• 16 Bonne NX, Zago S, Hosana G, Vinchon M, Van den Abbeele T, Fayoux P. Endonasal endoscopic approach for removal of intranasal nasal glial heterotopias. Rhinology 2012; 50 (02) 211-217
• 17 Sankhla SK, Jayashankar N, Khan GM. Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results. J Pediatr Neurosci 2015; 10 (04) 308-316
• 18 Banu MA, Rathman A, Patel KS. et al. Corridor-based endonasal endoscopic surgery for pediatric skull base pathology with detailed radioanatomic measurements. Neurosurgery 2014; 10 (Suppl. 02) 273-293 , discussion 293
• 19 Giovannetti F, Mussa F, Priore P. et al. Endoscopic endonasal skull base surgery in pediatric patients. A single center experience. J Craniomaxillofac Surg 2018; 46 (12) 2017-2021
• 20 Kassam A, Thomas AJ, Snyderman C. et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 2007; 106 (2, suppl): 75-86
• 21 Ketcham AS, Wilkins RH, Vanburen JM, Smith RR. A combined intracranial facial approach to the paranasal sinuses. Am J Surg 1963; 106: 698-703
• 22 Sekhar LN, Nanda A, Sen CN, Snyderman CN, Janecka IP. The extended frontal approach to tumors of the anterior, middle, and posterior skull base. J Neurosurg 1992; 76 (02) 198-206
• 23 Munson PD, Moore EJ. Pediatric endoscopic skull base surgery. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (06) 571-576
• 24 de Divitiis E, Cappabianca P, Gangemi M, Cavallo LM. The role of the endoscopic transsphenoidal approach in pediatric neurosurgery. Childs Nerv Syst 2000; 16 (10,11): 692-696
• 25 McAteer JP, LaRiviere CA, Drugas GT, Abdullah F, Oldham KT, Goldin AB. Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review. JAMA Pediatr 2013; 167 (05) 468-475
• 26 Rhee D, Papandria D, Yang J. et al. Comparison of pediatric surgical outcomes by the surgeon's degree of specialization in children. J Pediatr Surg 2013; 48 (08) 1657-1663
• 27 London Jr. NR, Rangel GG, Walz PC. The expanded endonasal approach in pediatric skull base surgery: A review. Laryngoscope Investig Otolaryngol 2020; 5 (02) 313-325