Endoscopic endonasal approaches to anterior skull base defects in pediatric patients

Abstract

The surgical treatment of skull base defects in children reduces life-threatening risks, which include infections, CSF leaks, and enlargement or trauma of the sac. The endoscopic technique minimizes surgical scars and has little impact on brain tissue. The endoscopic endonasal approach to the anterior skull base helps to preserve the physiology of the nose and sinuses and reduces the impact on the still developing splanchnocranium in pediatric patients. It ensures a definitive repair of the defect and requires a very short inpatient period.

Predicting the limits of the endoscopic endonasal approach in children: a radiological anatomical study

“…8,9,18 Advances in surgical techniques and neuroimaging modalities have allowed the development of several imageguided, minimally invasive approaches to the CVJ, including the endoscopic endonasal approach (EEA). 6,7,11,12,14,15,20,21 This approach avoids the oropharyngeal complications of the traditional, open transoral approach, while providing a direct, less traumatic, and shorter route to the rostral CVJ. 3 Several studies have demonstrated the feasibility of this approach to the entire ventral midline skull base in pediatric patients.…”

“…3 Several studies have demonstrated the feasibility of this approach to the entire ventral midline skull base in pediatric patients. 12,15,23 One of the restrictions of the EEA to the CVJ, nonetheless, is its limited caudal exposure. Our group has previously described a novel method, the nasoaxial line (NAxL), to accurately predict the caudal limit of the EEA in adults.…”

Endoscopic endonasal multilayer repair of traumatic ethmoidal roof cerebrospinal fluid rhinorrhea in children

“…Hence, the importance of the above mentioned diagnostic criteria (bone defect and underlying fluid in an otherwise normally aerated sinus). In difficult cases, as in posttraumatic cases with multiple bony defects, or in cases where the paranasal sinuses are totally opacified, acquisition of CT images after intrathecal contrast administration may determine the culprit defect, but this needs the leak to be active [14][15][16].…”

Post-traumatic morbidity is frequent in children with frontobasilar fractures

“…A CSF leakage can currently increasingly also be treated using the endonasal endoscopic technique [21,22]. Surgical treatment should be considered for severely displaced fractures according to general principles with reduction and fixation respecting the impact on growth.…”