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J Neurol Surg B Skull Base
DOI: 10.1055/a-2048-7564
Original Article

The Utility of a “Second-Look” Debridement Following Endonasal Skull Base Surgery in the Pediatric Population

Michael T. Chang 
1   Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
,
Alice E. Huang
1   Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
,
Jennifer L. Quon
2   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
Juan C. Fernandez-Miranda
2   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States
,
Christopher Z. Wen
3   Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Jacob G. Eide
3   Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Rijul S. Kshirsagar 
3   Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Z Jason Qian
1   Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
,
Jayakar V. Nayak
1   Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
,
Peter H. Hwang
1   Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
,
Nithin D. Adappa
3   Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Zara M. Patel 
1   Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
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Abstract

Background Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second-look procedure may require general anesthesia; however, there is currently little evidence assessing the benefit of this practice.

Methods This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second-look debridement under general anesthesia following ESBS. Intraoperative findings, interventions performed, and perioperative complications were reviewed. Multivariate regression analysis was performed to identify associations between intraoperative findings and clinical factors.

Results We reviewed 69 cases of second-look debridements (age mean 8.6 ± 4.2 years, range: 2–18 years), occurring a mean of 18.3 ± 10.3 days following ESBS. All abnormal findings were noted in patients age ≤12 years. Synechiae were noted in 8.7% of cases, bacterial rhinosinusitis in 2.9%, and failed reconstruction with cerebrospinal fluid leak in 4.5% (two cases of flap malposition and one case of flap necrosis). All failed reconstructions were noted following expanded endonasal cases for craniopharyngioma, and in each case, a revision reconstruction was performed during the second-look surgery. Synechiae were not significantly associated with younger age, revision cases, or cases with reconstructive flaps. There were no perioperative complications.

Conclusion Second-look debridement under general anesthesia may be useful in the identification and intervention of sinonasal pathology following endoscopic skull base surgery, particularly in children ≤12 years old or those with pedicled flap reconstructions. Larger controlled studies are warranted to validate this practice and refine indications and timing of this second procedure.

Keywords

skull base - endoscopic - quality of life - sinonasal outcomes - postoperative care


Publication History

Received: 01 November 2022

Accepted: 01 March 2023

Accepted Manuscript online:
07 March 2023

Article published online:
30 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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