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J Neurol Surg B Skull Base 2023; 84(04): 336-348
DOI: 10.1055/a-1862-0321
Original Article

Anatomical Parameters and Growth of the Pediatric Skull Base: Endonasal Access Implications

Joshua Chen 
1   Department of Otolaryngology—Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
,
Christopher Pool 
1   Department of Otolaryngology—Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
,
Einat Slonimsky
2   Department of Radiology, Penn State Hershey Medical Center, Hershey, Pennsylvania United States
,
Tonya S. King
3   Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pennsylvania, United States
,
Sandeep Pradhan
3   Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pennsylvania, United States
,
Meghan N. Wilson
1   Department of Otolaryngology—Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
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Abstract

Objectives Endoscopic endonasal anterior skull base surgery has expanding use in the pediatric population, but the anatomy of pediatric patients can lead to limitations. This study aims to characterize the important anatomical implications of the pediatric skull base using computed tomography (CT) scans.

Design This study is designed as retrospective analysis.

Setting The study setting comprises of tertiary academic medical center.

Participants In total, 506 patients aged 0 to 18 who had undergone maxillofacial and or head CTs between 2009 to 2016 were involved.

Methods Measurements included piriform aperture width, nare to sella distance (NSD), sphenoid pneumatization, olfactory fossa depth, lateral lamella cribriform plate angles, and intercarotid distances (ICD) at the superior clivus and cavernous sinus. These patients were then subdivided into three age groups adjusting for sex. Analysis of covariance (ANCOVA) models were fit comparing between all age groups and by sex.

Results Piriform aperture width, NSD, sphenoid sinus pneumatization as measured using lateral aeration and anterior sellar wall thickness, olfactory fossa depth, and ICD at the cavernous sinus were significantly different among all age groups (p <0.0001). Our results show that mean piriform aperture width increased with each age group. The mean olfactory fossa depth also had consistent age dependent growth. In addition, ICD at the cavernous sinus showed age dependent changes. When comparing by sexes, females consistently showed smaller measurements.

Conclusion The process of skull base development is age and sex dependent. During preoperative evaluation of pediatric patients for skull base surgery piriform aperture width, sphenoid pneumatization in both the anterior posterior and lateral directions, and ICD at the cavernous sinus should be carefully reviewed.

Keywords

skull base surgery - anatomical differences - olfactory fossa depth - intercarotid distance


Publication History

Received: 07 February 2022

Accepted: 23 May 2022

Accepted Manuscript online:
25 May 2022

Article published online:
05 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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