J Neurol Surg B Skull Base 2017; 78(S 01): S1-S156
DOI: 10.1055/s-0037-1600587
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

CSF Leak Rate after Endoscopic Skull Base Tumor Resections in Children: A Single Institution Experience

Javan J. Nation
1   Rady Children’s Hospital/University of California, San Diego, California, United States
,
Alexis Lopez
2   University of California, San Diego, California, United States
,
Adam Deconde
2   University of California, San Diego, California, United States
,
Michael Levy
1   Rady Children’s Hospital/University of California, San Diego, California, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
02 March 2017 (online)

 

Introduction: The resection of skull base lesions can present reconstructive challenges particularly in pediatric patients. The fully endoscopic expanded endonasal approach (EEAs) has been shown to be safe and efficacious in pediatric patients.

Studies have shown that use of the nasoseptal flap (NSF) is possible in children. However, in the growing patient it is preferable to preserve natural anatomy when possible to avoid disrupting future growth.

Another factor complicating performance of an EEA in children is the inability of the very young to follow CSF precautions with decreased activity in the post-operative period. This non-observance could potentially lead to a higher rate of CSF leaks in children and the need for a more durable repair.

Methods: A retrospective chart review was done on pediatric patients up to age 20 who underwent EEA skull base resections from June 2014 to June 2016. IRB approval was obtained.

Results: Twenty-two children underwent an EEA for skull base tumors and there were no post-operative CSF leaks. Ages ranged from 1–19 years old (mean 12.0, median 13.5). The tumor pathology includes; 7 craniopharyngiomas, 7 pituitary adenomas, 3 Rathke cleft cysts, 1 encephalocele, 1 hamartoma, 1 chordoma, 1 dermoid cyst, and 1 unknown. The intra-operative CSF leak included 7 ‘high-flow leaks’, 7 ‘low-flow leaks’, and 8 cases with ‘no leak’. The typical skull base repair technique involved placement of fat in the sella, followed by placement of Alloderm in an under or overlay fashion, a possible nasoseptal flap, Gelfoam filling the sphenoid sinus, and placement of a Merocel nasal sponge × 7 days. All patients were instructed to follow strict CSF precautions until the posterior sphenoid wall was endoscopically confirmed to have healed.

Five of the ‘high-flow leaks’ were repaired with a nasoseptal flap, and 1 was not. Of the 5 ‘high flow leaks’ repaired with NSF, 4 were from craniopharyngioma resections and 1 was from a chordoma resection. Three of 5 NSF repairs were under the age of 10 (youngest age 4) and there was adequate defect coverage with the NSF. The 15 other cases were repaired without using a NSF, 7 of those cases had ‘low-flow leaks’ and 8 had ‘no leak’.

Discussion: The children did well after undergoing an EEA for skull base tumors with no post-operative CSF leaks. Five of the patients were 6 years old and younger, the CSF precaution observance in this population was variable however no nasal packing was pulled out prematurely. In this series all of the ‘low-flow leaks’ healed without the use of a nasoseptal flap. This is important in the pediatric population, because of the importance anatomy preservation.

Conclusion: Endoscopic skull base resections were performed in children with no post-operative CSF leaks and are a good surgical option. The intraoperative ‘low-flow’ and ‘no leak” cases were adequately repaired without a nasoseptal flap, and in ‘high-flow leaks” the NSF was able to reach the defect and provide adequate coverage.