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Anatomical Limitations for Endoscopic Endonasal

Skull Base Surgery in Pediatric PatientsJason R. Tatreau, BS; Mihir R. Patel, MD; Rupali N. Shah, MD; Kibwei A. McKinney, MD; Adam M. Zanation, MD

Department of OtolaryngologyHead and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.

METHODS

METHODS

RESULTS: PIRIFORM APERTURE WIDTH

RESULTS: PIRIFORM APERTURE WIDTH

RESULTS: SPHENOID BONE PNEUMATIZATION

RESULTS: SPHENOID BONE PNEUMATIZATION

INTRODUCTION

INTRODUCTION CONCLUSIONS

CONCLUSIONS

ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS

LITERATURE CITED

LITERATURE CITED

Expanded endonasal approaches (EEAs) to midline

sellar or parasellar skull base lesions have reduced

post-surgical morbidity and costs when compared with

transcranial approaches.1

EEAs to these lesions are potentially limited by

several boney sinonasal landmarks and critical

neurovascular structures:

1. piriform aperture2

2. sphenoid sinus pneumatization3

3. intercarotid distances4

The majority of surgical complications in pediatric

skull base approaches occurs in patients with sellar or

suprasellar pathologies.5

Developmental immaturity of the skull base and

appositional neurovasculature is likely to contribute to

this morbidity.

Age-related differences in midline skull base

anatomy relevant to EEAs have not been characterized.

Quantitative pediatric anatomical measurements

relevant to skull base approaches are lacking.

Our goal was to use radioanatomic analysis of

computed tomography (CT) scans to determine

anatomical limitations for trans-sphenoidal EEAs in

pediatric skull base procedures.

A retrospective radio-anatomic cross-sectional study

Age-stratification of patients (n=60)

Exclusion criteria: pre-existing conditions altering skull base anatomy (including

trauma)

previous sinus or skull base surgery

congenital midface anomalies

nasal polyposis

premature birth

Measurements: Averaged within age groups, 95% CI

Lengths: defined below

Percent pneumatization: the ratio of pneumatized bone to the total

length of that boney margin

Significantly different between patients under 2 years of age (17.2 0.5 mm) and adults

(22.2 1.3 mm) (p