Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth

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OBJECTIVE

Cranial base development plays a large role in anterior and vertical maxillary growth through 7 years of age, and the effect of early endonasal cranial base surgery on midface growth is unknown. The authors present their experience with pediatric endoscopic endonasal surgery (EES) and long-term midface growth.

METHODS

This is a retrospective review of cases where EES was performed from 2000 to 2016. Patients who underwent their first EES of the skull base before age 7 (prior to cranial suture fusion) and had a complete set of pre- and postoperative imaging studies (CT or MRI) with at least 1 year of follow-up were included. A radiologist performed measurements (sella-nasion [S-N] distance and angles between the sella, nasion, and the most concave points of the anterior maxilla [A point] or anterior mandibular synthesis [B point], the SNA, SNB, and ANB angles), which were compared to age- and sex-matched Bolton standards. A Z-score test was used; significance was set at p < 0.05.

RESULTS

The early surgery group had 11 patients, with an average follow-up of 5 years; the late surgery group had 33 patients. Most tumors were benign; 1 patient with a panclival arteriovenous malformation was a significant outlier for all measurements. Comparing the measurements obtained in the early surgery group to Bolton standard norms, the authors found no significant difference in postoperative SNA (p = 0.10), SNB (p = 0.14), or ANB (0.67) angles. The S-N distance was reduced both pre- and postoperatively (SD 1.5, p = 0.01 and p = 0.009). Sex had no significant effect. Compared to patients who had surgery after the age of 7 years, the early surgery group demonstrated no significant difference in pre- to postoperative changes with regard to S-N distance (p = 0.87), SNA angle (p = 0.89), or ANB angle (p = 0.14). Lesion type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group.

CONCLUSIONS

Though our cohort of patients with skull base lesions demonstrated some abnormal measurements in the maxillary-mandibular relationship before their operation, their postoperative cephalometrics fell within the normal range and showed no significant difference from those of patients who underwent operations at an older age. Therefore, there appears to be no evidence of impact of endoscopic endonasal skull base surgery on craniofacial development within the growth period studied.

ABBREVIATIONS A point = most concave point of anterior maxilla; AVM = arteriovenous malformation; B point = most concave point on anterior mandibular symphysis; EES = endoscopic endonasal surgery; GH = growth hormone; N = nasion; S = sella; UPMC = University of Pittsburgh Medical Center.
Article Information

Contributor Notes

Correspondence Paul A. Gardner: UPMC Center for Cranial Base Surgery, Pittsburgh, PA. gardpa@upmc.edu.INCLUDE WHEN CITING Published online January 11, 2019; DOI: 10.3171/2018.8.PEDS18183.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    AlQahtani ATurri-Zanoni MDallan IBattaglia PCastelnuovo P: Endoscopic endonasal resection of sinonasal and skull base malignancies in children: feasibility and outcomes. Childs Nerv Syst 28:190519102012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Ashok K: Craniofacial growth, diagnosis and treatment planning. Pocket Dentistry. (https://pocketdentistry.com/1-craniofacial-growth/#bib0030) [Accessed September 17 2018]

    • Search Google Scholar
    • Export Citation
  • 3

    Bassed RBBriggs CDrummer OH: Analysis of time of closure of the spheno-occipital synchondrosis using computed tomography. Forensic Sci Int 200:1611642010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Bothwell MRPiccirillo JFLusk RPRidenour BD: Long-term outcome of facial growth after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 126:6286342002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Broadbent BHGolden WH: Bolton Standards of Dentofacial Developmental Growth. St Louis: Mosby1975

    • Export Citation
  • 6

    Bütow KW: Craniofacial growth disturbance after skull base and associated suture synostoses in the newborn chacma baboon: a preliminary report. Cleft Palate J 27:2412521990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Cappabianca PCavallo LMEsposito FDe Divitiis OMessina ADe Divitiis E: Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. Adv Tech Stand Neurosurg 33:1511992008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Chivukula SKoutourousiou MSnyderman CHFernandez-Miranda JCGardner PATyler-Kabara EC: Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11:2272412013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Fagan JJSnyderman CHCarrau RLJanecka IP: Nasopharyngeal angiofibromas: selecting a surgical approach. Head Neck 19:3913991997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Franklin DFlavel A: Brief communication: timing of spheno-occipital closure in modern Western Australians. Am J Phys Anthropol 153:1321382014

  • 11

    Gruber DPBrockmeyer D: Pediatric skull base surgery. 1. Embryology and developmental anatomy. Pediatr Neurosurg 38:282003

  • 12

    Kapadia HShetye PRGrayson BHMcCarthy JG: Cephalometric assessment of craniofacial morphology in patients with Treacher Collins syndrome. J Craniofac Surg 24:114111452013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Khalili SPalmer JNAdappa ND: The expanded endonasal approach for the treatment of intracranial skull base disease in the pediatric population. Curr Opin Otolaryngol Head Neck Surg 23:65702015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Kuroda SWatanabe KIshimoto KNakanishi HMoriyama KTanaka E: Long-term stability of LeFort III distraction osteogenesis with a rigid external distraction device in a patient with Crouzon syndrome. Am J Orthod Dentofacial Orthop 140:5505612011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Locatelli DMassimi LRigante MCustodi VPaludetti GCastelnuovo P: Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 74:129813022010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    McGrath JGerety PADerderian CASteinbacher DMVossough ABartlett SP: Differential closure of the spheno-occipital synchondrosis in syndromic craniosynostosis. Plast Reconstr Surg 130:681e689e2012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Nie X: Cranial base in craniofacial development: developmental features, influence on facial growth, anomaly, and molecular basis. Acta Odontol Scand 63:1271352005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Paliga JTGoldstein JAVossough ABartlett SPTaylor JA: Premature closure of the spheno-occipital synchondrosis in Pfeiffer syndrome: a link to midface hypoplasia. J Craniofac Surg 25:2022052014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Prasad MShetty ASShantaram M: The Crouzan syndrome—a case report. J Clin Diagn Res 7:9599612013

  • 20

    Proffit WRFields HW JrSarver DM: Contemporary Orthodontics. St Louis: Mosby Elsevier2007

    • Export Citation
  • 21

    Rastatter JCSnyderman CHGardner PAAlden TDTyler-Kabara E: Endoscopic endonasal surgery for sinonasal and skull base lesions in the pediatric population. Otolaryngol Clin North Am 48:79992015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Rosenberg PArlis HRHaworth RDHeier LHoffman LLaTrenta G: The role of the cranial base in facial growth: experimental craniofacial synostosis in the rabbit. Plast Reconstr Surg 99:139614071997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Rowan NRWang EWGardner PAFernandez-Miranda JCSnyderman CH: Nasal deformities following nasoseptal flap reconstruction of skull base defects. J Neurol Surg B Skull Base 77:14182016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Sankhla SKJayashankar NKhan GM: Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results. J Pediatr Neurosci 10:3083162015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Scheuer LBlack S: Developmental Juvenile Osteology. New York: Academic Press2000

    • Export Citation
  • 26

    Senior BWirtschafter AMai CBecker CBelenky W: Quantitative impact of pediatric sinus surgery on facial growth. Laryngoscope 110:186618702000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Shirley NRJantz RL: Spheno-occipital synchondrosis fusion in modern Americans. J Forensic Sci 56:5805852011

  • 28

    Stapleton ALTyler-Kabara ECGardner PASnyderman CH: Endoscopic endonasal surgery for benign fibro-osseous lesions of the pediatric skull base. Laryngoscope 125:219922032015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Stapleton ALTyler-Kabara ECGardner PASnyderman CHWang EW: Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery. Int J Ped Otorhino 93:1631662017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Suri STompson BDCornfoot L: Cranial base, maxillary and mandibular morphology in Down syndrome. Angle Orthod 80:8618692010

  • 31

    Tatreau JRPatel MRShah RNMcKinney KAWheless SASenior BA: Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients. Laryngoscope 120:173017372010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Van Peteghem AClement PA: Influence of extensive functional endoscopic sinus surgery (FESS) on facial growth in children with cystic fibrosis. Comparison of 10 cephalometric parameters of the midface for three study groups. Int J Pediatr Otorhinolaryngol 70:140714132006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Williams PLBannister LHBerry MMCollins PDyson MDussek JE: Gray’s Anatomy. New York: Churchill Livingstone1995

    • Export Citation
  • 34

    Wolf GGreistorfer KJebeles JA: The endoscopic endonasal surgical technique in the treatment of chronic recurring sinusitis in children. Rhinology 33:971031995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Zucconi MWeber GCastronovo VFerini-Strambi LRusso FChiumello G: Sleep and upper airway obstruction in children with achondroplasia. J Pediatr 129:7437491996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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