Pedicled nasoseptal flap reconstruction for craniopharyngiomas in pediatric patients

Laibangyang, Anya; Rodgers, Shaun; Baron, Shanna; Schaeffer, B. Todd; Shikowitz, Mark J.; Mittler, Mark A.; Schneider, Steven J.

doi:10.1007/s00381-019-04238-5

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Nation et al operated on children ranging from 1.3 to 6 years of age with no reports of CSF leakage after surgery, 54 and Ghosh et al found similar success in young children 55 . These studies owe their success to judicious patient selection, detailed preoperative radioanatomic analysis of NSF dimensions, and use of stereotactic navigation 54–56 . However, small sample sizes in these studies limit the validity of their results.…”

Section: Discussionmentioning

confidence: 99%

“…55 These studies owe their success to judicious patient selection, detailed preoperative radioanatomic analysis of NSF dimensions, and use of stereotactic navigation. [54][55][56] However, small sample sizes in these studies limit the validity of their results. In future studies, comparisons of specific reconstruction methods and materials would be enlightening to the skull base surgery community.…”

Section: Postoperative Csf Leakmentioning

confidence: 99%

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Endonasal Endoscopic Surgery for Pediatric Sellar and Suprasellar Lesions: A Systematic Review and Meta‐analysis

Lee¹,

Cooper²,

Nguyen³

et al. 2020

Otolaryngol.--head neck surg.

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Objectives The advent of endonasal endoscopic skull base surgery (ESBS) has redefined the management of pediatric sellar and suprasellar lesions. To date, the outcomes of these procedures have not been systematically reviewed. This study performed a systematic review with meta-analysis of surgical outcomes for pediatric patients undergoing ESBS for sellar and suprasellar lesions. Data Sources PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane Library (Wiley). Review Methods Articles reporting on pediatric patients undergoing ESBS for craniopharyngiomas, pituitary adenomas, and Rathke’s cleft cysts were reviewed. The primary outcome was postoperative cerebrospinal fluid (CSF) leak. Secondary outcomes included endocrine, visual, and other complications. Results Twenty-five articles reporting on 554 patients were included. Overall postoperative CSF leak rate was 8.6%, with tumor-specific rates of 10.6% in craniopharyngiomas, 6.5% in pituitary adenomas, and 7.2% in Rathke’s cleft cysts ( P > .05). Older studies demonstrate higher postoperative CSF leak rates as compared with more recent studies (12.5% vs 6.1%, P = .0082). Younger children (8.9-12.6 years old) experienced a higher rate of postoperative CSF leaks as compared with older children (13.0-16.6 years old; 12.9% vs 4.9%, P = .0016). Additional postoperative complications included diabetes insipidus (26.7%), hypopituitarism (46.6%), visual deficits (2.6%), meningitis (3.4%), and weight gain (3.4%). Conclusion ESBS for pediatric sellar and suprasellar lesions is overall an effective management approach with an increasingly favorable risk-benefit profile. Younger children may be more susceptible to postoperative CSF leak as compared with older pediatric patients. Tumor type does not appear to be an independent risk factor for postoperative CSF leak in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Postoperative Csf Leakmentioning

confidence: 99%

Endonasal Endoscopic Surgery for Pediatric Sellar and Suprasellar Lesions: A Systematic Review and Meta‐analysis

Lee¹,

Cooper²,

Nguyen³

et al. 2020

Otolaryngol.--head neck surg.

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“…With craniopharyngiomas in particular, the authors noted in a separate publication that the use of a NSF dramatically decreased the rate of post-operative CSF leak from 58 to 5% (31). As a testament to the versatility of this technique, it has also been successfully utilized following EEA to skull base lesions in pediatric cohorts, in spite of initial concerns regarding the small size of the nasal septum in children (32,33). Certain skull base tumors, such as craniopharyngiomas, chordomas and chondrosarcomas have a propensity for local recurrence, necessitating revisional surgery for further tumor resection.…”

Section: Pedicled Nasoseptal Flapmentioning

confidence: 99%

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

2020

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Following the introduction of fully endoscopic techniques for the resection of pituitary tumors, there was a rapid expansion of the indications for endonasal endoscopic surgery to include extrasellar tumors of the skull base. These techniques offer significant advantages over traditional open surgical approaches to the skull base, including improved tumor resection, and better post-operative neurological outcomes. Following their introduction, however, the initial rate of post-operative CSF leak was unacceptably high. Post-operative CSF leak following skull base surgery is a major source of morbidity, and can lead to the development of life-threatening intracranial infection. The use of vascularized naso-septal flaps transformed the management of these patients, significantly reducing the rate of post-operative CSF leak and increasing the number of patients that could benefit from this less invasive treatment modality. Adequate repair of iatrogenic defects in the skull base is of crucial importance for patients with skull base tumors, as the development of a post-operative CSF leak, and the associated complications can significantly delay the administration of the adjunctive oncological therapies these patients require. In this review, we provide an overview of the latest evidence regarding skull base reconstruction following endoscopic skull base surgery, and describe the skull base repair technique in use at our institution.

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“…14 Anatomic studies suggest that flaps of up to 5 cm in length can be obtained in the pediatric population before rapid septal growth at 10 to 13 years. 15 Thus, there is sufficient tissue to repair large anterior palatal fistulas.…”

Section: Discussionmentioning

confidence: 99%

“Nasal Septal Flaps for Repair of Large or Recurrent Palatal Fistula: Report of Technique and Four Year Experience”

Fox

McKenzie²,

Morris

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Large or multiply recurrent oronasal fistulas following cleft palate repair present a challenging problem. Nasal septal mucoperichondrial flaps have been widely used for repair of skull base defects; however, their use in the repair of oronasal cleft palate fistulas has not previously been described. In this pilot study, the authors describe anterior palatal fistula repair using a nasal septal flap and review their experience with this technique over 4 years. Fourteen patients with anterior palatal fistulas not amenable to repair using local palatal flaps were included for analysis. The mean size of the fistula was 12 mm in maximum dimension. Flap healing with complete or near-complete closure of fistula was achieved in 13 patients (93%). Five of these patients had a small, slit-like residual fistula that was asymptomatic. Nasal septal flaps are a new technique for repair of large or recurrent palatal fistulas. The procedure is well-tolerated with minimal side effects, high success rate, and low incidence of recurrence.

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Pedicled nasoseptal flap reconstruction for craniopharyngiomas in pediatric patients

Cited by 7 publications

References 12 publications

Endonasal Endoscopic Surgery for Pediatric Sellar and Suprasellar Lesions: A Systematic Review and Meta‐analysis

Endonasal Endoscopic Surgery for Pediatric Sellar and Suprasellar Lesions: A Systematic Review and Meta‐analysis

Methods of Skull Base Repair Following Endoscopic Endonasal Tumor Resection: A Review

“Nasal Septal Flaps for Repair of Large or Recurrent Palatal Fistula: Report of Technique and Four Year Experience”

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