The reconstruction of skull base defects in infants using pedicled nasoseptal flap—a review of four cases

Shah, Nishit; Deopujari, Chandrashekhar; Bommakanti, Vyshanavi

doi:10.1007/s00381-019-04132-0

Cited by 16 publications

(7 citation statements)

References 6 publications

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“…A total of 25 studies met inclusion criteria for qualitative and quantitative analysis. 1,7,11,21-42 See Figure 1 for a summary of search results. A funnel plot indicating less likelihood of publication bias across studies is presented in Figure 2 .…”

Section: Resultsmentioning

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: Resultsmentioning

confidence: 99%

“…Initial screening by title/abstract eliminated an additional 569 articles, and the remaining 70 underwent full‐text review for eligibility. A total of 25 studies met inclusion criteria for qualitative and quantitative analysis 1,7,11,21–42 . See Figure 1 for a summary of search results.…”

Section: Resultsmentioning

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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“…[ 10 ] Therefore, it is essential to develop new techniques for closing and to avoid possible CSF leaks. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Pediatric skull base tumors: A management challenge

et al. 2021

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A BSTRACT Context: Skull base tumors are varied in children and are particularly challenging to pediatric neurosurgeons, with few papers in the literature describing the evolution, complications, and outcome. The authors evaluated long-term outcomes in children submitted to skull base tumor surgery and performed a literature review. Aims: The aim of this study was to analyze surgical results, complications, and outcomes, on comparison with previous publications. Materials and Methods: A retrospective analysis of children undergoing surgery at a single institution between 2000 and 2018 for lesions of the cranial base was carried out. In addition, a literature review was carried out describing a total of 115 children operated on for skull base tumors. Statistical Analysis: Chi-squared and Fisher’s exact tests were performed to compare the distribution of categorical variables and a nonparametric Mann–Whitney U test was used to perform intergroup comparisons of continuous variables. Results: Seventeen children ranging in age from 8 months to 17 years (mean, 10.9 years) underwent skull base approaches. Tumor types included schwannoma, meningioma, chondroid chordoma, mature teratoma, epidermoid cyst, hemangiopericytoma, rhabdomyosarcoma, myofibroblastic inflammatory tumor, fibromyxoid sarcoma, Crooke’s cell adenoma, ossifying fibroma, osteoblastoma, nasopharyngeal angiofibroma and Ewing’s sarcoma. Gross total resection was achieved in 6 patients (35.3%), 12 patients (70.6%) had benign histology, and 5 patients (29.4%) had a malignant tumor. Transient postoperative cerebrospinal fluid leak affected only one patient. Thirteen children (76.4%) had a residual neurological deficit at last follow-up evaluation. Three (17.6%) surviving patients received adjuvant therapy. The rate of recurrence or lesion progression was 17.6%. Conclusions: Skull base tumors in children present a therapeutic challenge because of their unique pathological composition and can lead to considerable morbidity and mortality in pediatric age.

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“…Prospective clinical data and radioanatomic analysis show that in patients between 13 and 14 years old, the septum is approximately the same size as that of an adult. A more recent study argues that skull-base defects in infants can be reconstructed safely and effectively using the nasoseptal flap, without any potential effect on septal or craniofacial growth, as the flap is harvested only on the one side with normal mucosal cover on the other side [19]. Indeed, this is now the gold standard for repairing skull-base defects.…”

Section: Discussionmentioning

confidence: 99%

Operative Procedure in a Suprasellar Paediatric Lesion of the Optic Chiasm with Hydrocephalus Caused by a Papillary Glioneuronal Tumour

et al. 2021

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Introduction: Paediatric tumours in the sellar and parasellar regions present clinical and surgical challenges due to anatomical position and behaviour. We illustrate a rare case which caused obstructive hydrocephalus. Case Presentation: The study included a 14-year-old girl with a glioneuronal tumour (40 mm) originating from the optic chiasm, obliterating the aqueduct, with consequent triventricular hydrocephalus. The patient underwent extended endoscopic endonasal surgery and repair of the skull-base deficiency using a multi-layer technique with fascia lata. The 12-month follow-up showed no complications or recurrences, with recovery in visual acuity. Conclusion: The immediate placement of external ventricular drainage, in combination with an extended trans-sphenoidal approach, is a safe and feasible option to treat suprasellar paediatric lesions with hydrocephalus.

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The reconstruction of skull base defects in infants using pedicled nasoseptal flap—a review of four cases

Cited by 16 publications

References 6 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

Pediatric skull base tumors: A management challenge

Operative Procedure in a Suprasellar Paediatric Lesion of the Optic Chiasm with Hydrocephalus Caused by a Papillary Glioneuronal Tumour

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