CSF leak after endoscopic skull base surgery in children: A single institution experience.
INTRODUCTION
The endoscopic expanded endonasal approach (EEA) has been shown to be a safe and effective surgical technique in the resection of pediatric skull base lesions. Cerebrospinal fluid (CSF) leaks are among the most common complications of this approach. Here we review skull base resections using EEA in pediatric patients at our single institution, to identify potential risk factors for this surgical complication.


METHODS
A retrospective chart review was conducted on pediatric patients at our single institution for patients 19 years-old and under, who underwent an EEA for resection of a skull base tumor.


RESULTS
Thirty-nine pediatric patients (ages 1-19 years) with 8 different tumor pathologies underwent an EEA for resection of their skull base tumors. 21 patients experienced an intraoperative CSF leak, of which 10 (48%) were "high-flow" leaks and 11 (52%) were "low-flow" leaks. Nasoseptal flaps were only used to repair the intraoperative "high flow" leaks (n = 10), and "low flow" and "no leaks" were repaired with allograft and fat. No patients experienced a post-operative CSF leak.


CONCLUSION
In our pediatric series, the skull base repair algorithm of using an NSF only in cases of "high flow" intraoperative leaks was effective, and no post-operative CSF leaks occurred. Not using an NSF in cases of "low-flow" or "no leak" cases allows for decreased anatomical disruption in the growing patient.
['Nation|Javan|J|', 'Schupper|Alexander J|AJ|', 'Deconde|Adam|A|', 'Levy|Michael|M|']
D000293:Adolescent D000465:Algorithms D065634:Cerebrospinal Fluid Leak D002648:Child D002675:Child, Preschool D004724:Endoscopy D006801:Humans D007223:Infant D007431:Intraoperative Complications D009300:Nasal Septum D011183:Postoperative Complications D012189:Retrospective Studies D012307:Risk Factors D019292:Skull Base Neoplasms D013524:Surgical Flaps D055815:Young Adult
CSF leak EEA Surgical complications Expanded endonasal endoscopic approach Pediatric endoscopic endonasal approach Pediatric skull base surgery