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  • Endoscopic Endonasal Skull Base Surgery in Pediatric Patients and Impact on Midface Growth

    Final Number:

    Wendy Chen MD, MS; Shih-Dun Liu MS; Barton F Branstetter MD; Yue-Fang Chang PhD; Lindsay A Schuster DMD, MS; Paul A. Gardner MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Cranial base development plays a large role in anterior and vertical maxillary growth through age 7, and the effect of early endonasal cranial base surgery on midface growth is unknown. We present our experience with pediatric endoscopic endonasal surgery and long-term midface growth.

    Methods: This is a retrospective review (2000-2016). Pediatric patients were grouped by age at first endoscopic endonasal skull base surgery (<7yo and >7yo). Included patients had both pre- and post-operative (>1yr) imaging. Radiologists performed measurements (Sella-Nasion distance and angles from S-N to maxilla and mandible (SNA, SNB, ANB)), which were compared to age- and sex-matched Bolton standards. Z score test was used; significance was set at p<0.05.

    Results: The <7yo group had 11 patients, averaging follow-up of 5yrs; the >7yo group had 33 patients. Most tumors were benign; one patient with a panclival AVM was a significant outlier for all measurements. Comparing the <7yo group to Bolton standard norms, there was no significant difference in post-operative SNA (p=0.10), SNB (p=0.14), or ANB (0.67). SN distance was reduced both pre- and post-operatively (SD=1.5, p=0.01 and p=0.009). Sex had no significant effect. Compared to patients who had surgery in the >7yo group, the <7yo group demonstrated no significant difference in pre- to post-operative changes with regard to S-N (p=0.87), SNA (p=0.89), and ANB (p=0.14). Tumor type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group.

    Conclusions: Though our cohort of patients with skull base tumors demonstrate some abnormal measurements before their operation, their post-operative cephalometrics fall within normal standard deviations and generally have no significant difference compared to patients who underwent operations at an older age. Therefore, there appears to be no evidence of impact of endoscopic endonasal skull base surgery on craniofacial development within the growth period studied.

    Patient Care: Cranial base development plays a large role in anterior and vertical maxillary growth, but the effect of early cranial base surgery on midface growth is unknown. This is an important question to answer to counsel families and for making considerations for timing of surgery. J Neurosurg Pediatr. 2013;11(5):533-42.

    Learning Objectives: To understand that in our cohort, we did not find facial growth abnormalities in children undergoing endscopic endonasal skull base surgery prior to age 7y.

    References: Banh et al. Impact of skull base development on endonasal endoscopic surgical corridors. J Neurosurg Pediatr. 2014;13(2):155-69. Brockmeyere et al. Pediatric skull base surgery: Experience and outcomes in 55 patients. Pediatr Neurosurg. 2003;38(1):9-15. Kim et al. Pediatric bypasses for aneurysms and skull base tumors: short- and long-term outcomes.

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