Endoscopic endonasal skull base surgery in the pediatric population.

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Journal of neurosurgery. Pediatrics Pub Date : 2013-03-01 Epub Date: 2012-12-14 DOI:10.3171/2012.10.PEDS12160
Srinivas Chivukula, Maria Koutourousiou, Carl H Snyderman, Juan C Fernandez-Miranda, Paul A Gardner, Elizabeth C Tyler-Kabara
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引用次数: 110

Abstract

Object: The use of endoscopic endonasal surgery (EES) for skull base pathologies in the pediatric population presents unique challenges and has not been well described. The authors reviewed their experience with endoscopic endonasal approaches in pediatric skull base surgery to assess surgical outcomes and complications in the context of presenting patient demographics and pathologies.

Methods: A retrospective review of 133 pediatric patients who underwent EES at our institution from July 1999 to May 2011 was performed.

Results: A total of 171 EESs were performed for skull base tumors in 112 patients and bony lesions in 21. Eighty-five patients (63.9%) were male, and the mean age at the time of surgery was 12.7 years (range 2.3-18.0 years). Skull base tumors included angiofibromas (n = 24), craniopharyngiomas (n = 16), Rathke cleft cysts (n = 12), pituitary adenomas (n = 11), chordomas/chondrosarcomas (n = 10), dermoid/epidermoid tumors (n = 9), and 30 other pathologies. In total, 19 tumors were malignant (17.0%). Among patients with follow-up data, gross-total resection was achieved in 16 cases of angiofibromas (76.2%), 9 of craniopharyngiomas (56.2%), 8 of Rathke cleft cysts (72.7%), 7 of pituitary adenomas (70%), 5 of chordomas/chondrosarcomas (50%), 6 of dermoid/epidermoid tumors (85.7%), and 9 cases of other pathologies (31%). Fourteen patients received adjuvant radiotherapy, and 5 received chemotherapy. Sixteen patients (15.4%) showed tumor recurrence and underwent reoperation. Bony abnormalities included skull base defects (n = 12), basilar invagination (n = 4), optic nerve compression (n = 3) and trauma (n = 2); preexisting neurological dysfunction resolved in 12 patients (57.1%), improved in 7 (33.3%), and remained unchanged in 2 (9.5%). Overall, complications included CSF leak in 14 cases (10.5%), meningitis in 5 (3.8%), transient diabetes insipidus in 8 patients (6.0%), and permanent diabetes insipidus in 12 (9.0%). Five patients (3.8%) had transient and 3 (2.3%) had permanent cranial nerve palsies. The mean follow-up time was 22.7 months (range 1-122 months); 5 patients were lost to follow-up.

Conclusions: Endoscopic endonasal surgery has proved to be a safe and feasible approach for the management of a variety of pediatric skull base pathologies. When appropriately indicated, EES may achieve optimal outcomes in the pediatric population.

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儿童人群的鼻内窥镜颅底手术。
目的:使用鼻内窥镜手术(EES)的颅底病理儿科人群提出了独特的挑战,并没有很好地描述。作者回顾了他们在儿童颅底手术中内镜内鼻入路的经验,以评估在呈现患者人口统计学和病理的背景下的手术结果和并发症。方法:对1999年7月至2011年5月在我院接受EES治疗的133例患儿进行回顾性分析。结果:颅底肿瘤112例共171例,骨病变21例共21例。85例患者为男性(63.9%),手术时平均年龄12.7岁(范围2.3-18.0岁)。颅底肿瘤包括血管纤维瘤(24例)、颅咽管瘤(16例)、Rathke裂囊(12例)、垂体腺瘤(11例)、脊索瘤/软骨肉瘤(10例)、皮样/表皮样肿瘤(9例)和其他30种病理。恶性肿瘤19例(17.0%)。在随访患者中,血管纤维瘤16例(76.2%),颅咽管瘤9例(56.2%),Rathke裂囊肿8例(72.7%),垂体腺瘤7例(70%),脊索瘤/软骨肉瘤5例(50%),皮样/表皮样瘤6例(85.7%),其他病理9例(31%)实现全切。辅助放疗14例,化疗5例。16例(15.4%)出现肿瘤复发并再次手术。骨异常包括颅底缺损(n = 12)、颅底内陷(n = 4)、视神经受压(n = 3)和外伤(n = 2);先前存在的神经功能障碍12例(57.1%)得到缓解,7例(33.3%)得到改善,2例(9.5%)保持不变。总的来说,并发症包括脑脊液漏14例(10.5%),脑膜炎5例(3.8%),短暂性尿崩症8例(6.0%),永久性尿崩症12例(9.0%)。5例(3.8%)为短暂性脑神经麻痹,3例(2.3%)为永久性脑神经麻痹。平均随访时间22.7个月(1 ~ 122个月);5例患者失访。结论:鼻内窥镜手术已被证明是一种安全可行的方法来处理各种儿童颅底病变。在适当的适应症下,EES可以在儿科人群中获得最佳结果。
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来源期刊
Journal of neurosurgery. Pediatrics
Journal of neurosurgery. Pediatrics 医学-临床神经学
CiteScore
3.40
自引率
10.50%
发文量
307
审稿时长
2 months
期刊介绍: Information not localiced
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