The impact of expanded endonasal skull base surgery on midfacial growth in pediatric patients.

Autor: Parasher AK; Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, Florida, U.S.A.; Department of Health Policy and Management, University of South Florida, Tampa, Florida, U.S.A., Lerner DK; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Mount Sinai, New York, New York, U.S.A., Glicksman JT; Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.; North Shore ENT, Danvers, Massachusetts, U.S.A., Storm PB; Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A., Lee JYK; Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A., Vossough A; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A., Brooks S; Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A., Palmer JN; Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A., Adappa ND; Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2020 Feb; Vol. 130 (2), pp. 338-342. Date of Electronic Publication: 2019 May 09.
DOI: 10.1002/lary.28063
Abstrakt: Objective: Surgical resection of skull base tumors in children is increasingly accomplished through an expanded endonasal approach (EEA). We aim to evaluate the potential effect of the EEA on midfacial growth as a result of iatrogenic damage to nasal growth zones.
Methods: We performed a retrospective review of children undergoing craniopharyngioma resection via an open transcranial or EEA. Pre- and postoperative magnetic resonance imaging was evaluated for growth in four midfacial measurements based on established cephalometric landmarks: anterior midface height, posterior midface height, palatal length, and sella-nasion distance. Statistical analysis was conducted using a mixed-effects linear regression model.
Results: Twenty-two patients underwent an EEA (n = 12) or open transcranial approach (n = 10) for tumor resection with 3 years of imaging follow-up. There was no difference in midfacial growth between groups for each measurement. Compared to the open group, patients undergoing EEA demonstrated relative anterior midface height growth of -0.42 mm (P = 0.880), posterior midface height growth of -0.44 mm (P = 0.839), palatal length growth of 0.35 mm (P = 0.894), and sella-nasion distance growth of -2.16 (P = 0.365).
Conclusion: We found no difference in midfacial growth measurements between patients undergoing craniopharyngioma resection via an EEA and the open transcranial route after 3 years of imaging follow-up. Preliminary results on midfacial growth demonstrate that the EEA is a safe alternative to traditional transcranial approaches for the pediatric population. Further investigation with larger sample size and longer duration of follow-up is warranted to more thoroughly investigate the long-term implications of the EEA to the skull base.
Level of Evidence: 3 Laryngoscope, 130:338-342, 2020.
(© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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