Pediatric Endoscopic Endonasal Skull Base Reconstruction Surgical Techniques: A Systematic Review and Meta-analysis

Introduction: Recent advances in minimally invasive endoscopic technology has led to widespread adoption of endoscopic endonasal skull base reconstruction (EESBR) as the preferred approach for managing skull base tumors. Many studies have markedly reported superior success rates when compared to conventional craniotomy approaches. However, complications such as cerebrospinal fluid leaks, infections, cerebral abscesses, or cranial nerve deficits may still occur. To date, no studies have evaluated surgical outcomes across all lesions locations (anterior, middle, posterior) based on graft type. Various materials, including autologous grafts, such as fat or fascia grafts, are utilized for successful reconstruction. This review and meta-analysis aims to assess the efficacy of modern autologous graft-based reconstruction techniques, as documented in pediatric populations.

Methods: We searched MEDLINE and PubMed for articles published between January 1, 1990 and February 2, 2021. Two independent reviewers AM and MZ screened titles and abstracts for relevance, following PRISMA guidelines. Following full-text analysis, we arbitrated the 2 lists to include 24 studies. The PROSPERO and Cochrane databases were searched to ensure that no overlapping systematic reviews had been previously published. Individualized data from included studies was manually extracted and compiled for further analysis.

Results: Of the 250 patients identified, 97 (38.8%) had fat grafts, 63 (25.5%) had dural replacement, 38 (15.2%) had bone flaps, 81 (32.4%) had nasoseptal flaps, and 37 (14.8%) had fascia grafts. The use of a nasoseptal flap was correlated with an increased incidence of complications (14.81%) compared to all other previously mentioned skull base reconstruction techniques (average: 3.81%) (p < 0.001, [Table 1]). The mean follow-up time for patients was 27.1 months. The presence of a complication was correlated with a shorter mean follow-up time (16.7 months vs. 28.0 months, p = 0.024).

Conclusion: Our comprehensive systematic review and meta-analysis reveals that while EESBR have demonstrated promising outcomes, the choice of graft type warrants careful consideration due to their association with higher complication rates. These insights contribute to the ongoing understanding of EESBR management strategies and emphasize the need for tailored approaches to optimize patient outcomes.

Table 1 The incidence of complications based on chosen reconstruction technique

	N	%	P-value
Fat graft
Complication	5	5.15%	0.313
No complication	92	94.85%
Dural Replacement
Complication	3	4.76%	0.382
No complication	60	95.24%
Bone Flap
Complication	1	2.63%	0.235
No complication	37	97.37%
Nasoseptal Flap
Complication	12	14.81%	0.001
No Complication	69	85.19%
Fascia Graft
Complication	1	2.70%
No Complication	36	97.30%	0.249

Publication History

Article published online:
05 February 2024