Author(s)
Adam Kaufman, MD, PhD
Edward C. Kuan, MD, MBA
David Lerner, BS
Phillip B. Storm, MD
Jmes N. Palmer, MD, FARS
Nithin D. Adappa, MD, FARS
Affiliation(s)
Hospital of the University of the Pennsylvania
Abstract:
INTRODUCTION: Currently, due to the rarity of pathology, there is limited data surrounding outcomes of pediatric skull base surgery. Traditionally, surgeons have proceeded with caution when electing endonasal endoscopic transsellar/transplanum approaches to the skull base in pediatric patients due to poor sphenoid pneumatization. In this study, we review outcomes of endoscopic pediatric skull base surgery based on sphenoid pneumatization patterns.METHODS: Retrospective chart review of all cases of pediatric (age < 18 years) craniopharyngioma managed via an endonasal endoscopic approach at a tertiary academic medical center.RESULTS: A total of 30 patients were included in the analysis. The mean age was 8.6 ± 3.9 years. 22 (73%) patients were male. Presellar, sellar/postsellar, and conchal sphenoid pneumatizations were found in 9, 11, and 10 patients, respectively. There was no significant association between sphenoid pneumatization pattern and extent of resection (gross vs. subtotal, p=0.058), postoperative cerebrospinal fluid (CSF) leak (p=0.576), intraoperative estimated blood loss (p=0.067), and length of stay (p=0.882). On multivariate analysis, after accounting for age, sex, preoperative cranial nerve involvement, cavernous sinus invasion, and suprasellar extension, there remained no significant association between sphenoid pneumatization pattern and extent of resection (p=0.109) and postoperative CSF leak (p=0.880).CONCLUSION: Sphenoid pneumatization pattern does not appear to affect outcomes in endoscopic skull base surgery in the pediatric population. Importantly, lack of sphenoid pneumatization does not impede gross total resection or increase complications. Thorough knowledge of the anatomy during the endoscopic approach is critical in order to optimize outcomes.