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Pedicled nasoseptal flap reconstruction for craniopharyngiomas in pediatric patients

  • Anya Laibangyang
  • Shaun D. RodgersEmail author
  • Shanna L. Baron
  • B. Todd Schaeffer
  • Mark Shikowitz
  • Mark A. Mittler
  • Steven J. Schneider
Focus Session
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Abstract

Purpose

Though the use of the pedicled nasoseptal flap (NSF), a reconstructive technique used after endoscopic endonasal approaches (EEA) for resection of craniopharyngiomas, has been shown to reduce the occurrence of post-operative cerebrospinal fluid (CSF) leaks in adults, less is known about its use in pediatric populations, specifically in children under the age of 7. The goal of this retrospective cohort study is to determine the viability of the pedicled NSF for pediatric patients.

Methods

Retrospective review of 12 pediatric patients (ages 2–16) undergoing 13 NSF reconstructions after resection of craniopharyngiomas. Radioanatomic analysis of computed tomography (CT) scans was utilized to classify the pneumatization of the sphenoid sinus depending on the thickness of the sphenoid bone margin. Intercarotid distances were measured from magnetic resonance imaging (MRI) scans to assess the feasibility of this reconstruction technique in pediatric patients.

Results

At the time of surgery, all patients were noted to have adequate NSF length and width. No post-operative high-flow CSF leaks were found within the group. Lack of pneumatization of the sphenoid sinus and narrow intercarotid distances in the youngest of patients did not lead to negative clinical outcomes.

Conclusions

Based on our results and experience, the pedicled nasoseptal flap is a viable reconstructive option after EEA in the pediatric population, including even the youngest of patients. In these patients, a narrowed window between the intercarotid arteries and the lack of pneumatization of the sphenoid sinus present a challenge that can be overcome by using stereotactic navigation and advanced endoscopic techniques.

Keywords

Pediatric neurosurgery Nasoseptal flap Craniopharyngioma Reconstruction 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study for the findings specified in this paper.

References

  1. 1.
    Ben-Ari O, Wengier A, Ringel B, Niederman NNC, Ram Z, Margalit N et al (2018) Nasoseptal flap for skull base reconstruction in children. J Neurol Surg B 79:37–41.  https://doi.org/10.1055/s-0037-1617435 CrossRefGoogle Scholar
  2. 2.
    Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC (2013) Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11:227–241.  https://doi.org/10.3171/2012.10.PEDS12160 CrossRefGoogle Scholar
  3. 3.
    Ghosh A, Hatten K, Learned KO, Rizzi MD, Lee JY, Storm PB, Palmer JN, Adappa ND (2015) Pediatric nasoseptal flap reconstruction for suprasellar approaches. Laryngoscope 125:2451–2456.  https://doi.org/10.1002/lary.25395 CrossRefGoogle Scholar
  4. 4.
    Gump WC (2015) Endoscopic endonasal repair of congenital defects of the anterior skull base: developmental considerations and surgical outcomes. J Neurol Surg B Skull Base 76:291–295.  https://doi.org/10.1055/s-0034-1544120 CrossRefGoogle Scholar
  5. 5.
    Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Synderman CH et al (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882–1886.  https://doi.org/10.1097/01.mlg.0000234933.37779.e4 CrossRefGoogle Scholar
  6. 6.
    Kassam A, Thomas AJ, Carrau RL, Snyderman C, Vescan A, Prevedello D et al (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63:ONS44–ONS53.  https://doi.org/10.1227/01.neu.0000335010.53122.75 Google Scholar
  7. 7.
    Kassam A, Thomas AJ, Snyderman C, Carrau R, Gardner P, Mintz A, Kanaan H, Horowitz M, Pollack IF (2007) Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 106:75–86.  https://doi.org/10.3171/ped.2007.106.2.75 Google Scholar
  8. 8.
    Patel MR, Stadler ME, Synderman CH, Carrau RL, Kassam AB, Germanwala AV et al (2010) How to choose? Endoscopic skull base reconstructive options and limitations. Skull Base 20:397–404.  https://doi.org/10.1055/s-0030-1253573 CrossRefGoogle Scholar
  9. 9.
    Rivera-Serrano CM, Synderman CH, Gardner P, Prevedello D, Wheless S, Kassam AB (2011) Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 121:990–993.  https://doi.org/10.1002/lary.21419 CrossRefGoogle Scholar
  10. 10.
    Shah RN, Surowitz JB, Patel MR, Huang BY, Synderman CH, Carrau RL et al (2009) Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 119:1067–1075.  https://doi.org/10.1002/lary.20216 CrossRefGoogle Scholar
  11. 11.
    Tatreau JR, Patel MR, Shah RN, McKinney KA, Wheless SA, Senior BA et al (2010) Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients. Laryngoscope 120:1730–1737.  https://doi.org/10.1002/lary.20964 CrossRefGoogle Scholar
  12. 12.
    Yamada S, Fukuhara N, Yamaguchi-Okada M, Nishioka H, Takeshita A, Takeuchi Y, Inoshita N, Ito J (2018) Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study. J Neurosurg Pediatr 21:549–562.  https://doi.org/10.3171/2017.10.PEDS17254 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadUSA
  2. 2.Division of Pediatric NeurosurgeryCohen Children’s Medical CenterNew Hyde ParkUSA
  3. 3.Department of OtolaryngologyLong Island Jewish Medical CenterQueensUSA

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