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
