1
|
Lee L, Dawood E, Vorona G, Richard H, Manzoor NF. Pediatric progressive facial nerve palsy with associated intratemporal mass. Am J Otolaryngol 2024; 45:104279. [PMID: 38604104 DOI: 10.1016/j.amjoto.2024.104279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Lawrance Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Emaan Dawood
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gregory Vorona
- Department of Radiology, Children's Hospital of Richmond, at VCU, 1101 E. Marshall St., Room 4-052, Richmond, VA, USA
| | - Hope Richard
- Department of Pathology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
| |
Collapse
|
2
|
Neurosurgical Treatment and Outcome of Pediatric Skull Base Lesions: A Case Series and Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020216. [PMID: 36832345 PMCID: PMC9954611 DOI: 10.3390/children10020216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Pediatric skull base lesions occur rarely and are of various etiologies. Traditionally, open craniotomy has been the treatment of choice; however, nowadays, endoscopic approaches are increasingly applied. In this retrospective case series, we describe our experience in treating pediatric skull base lesions and provide a systematic overview of the literature on the treatment and outcome of pediatric skull base lesions. METHODS We conducted a retrospective data collection of all pediatric patients (<18 years) treated for a skull base lesion at the Division of Pediatric Neurosurgery, University Children's Hospital Basel, Switzerland, between 2015 and 2021. Descriptive statistics and a systematic review of the available literature were additionally conducted. RESULTS We included 17 patients with a mean age of 8.92 (±5.76) years and nine males (52.9%). The most common entity was sellar pathologies (n = 8 47.1%), with craniopharyngioma being the most common pathology (n = 4, 23.5%). Endoscopic approaches, either endonasal transsphenoidal or transventricular, were used in nine (52.9%) cases. Six patients (35.3%) suffered from transient postoperative complications, while in none of the patients these were permanent. Of the nine (52.9%) patients with preoperative deficits, two (11.8%) showed complete recovery and one (5.9%) partial recovery after surgery. After screening 363 articles, we included 16 studies with a total of 807 patients for the systematic review. The most common pathology reported in the literature confirmed our finding of craniopharyngioma (n = 142, 18.0%). The mean PFS amongst all the studies included was 37.73 (95% CI [36.2, 39.2]) months, and the overall weighted complication rate was 40% (95% CI [0.28 to 0.53] with a permanent complication rate of 15% (95% CI [0.08 to 0.27]. Only one study reported an overall survival of their cohort of 68% at five years. CONCLUSION This study highlights the rarity and heterogeneity of skull base lesions in the pediatric population. While these pathologies are often benign, achieving GTR is challenging due to the deep localization of the lesions and eloquent adjacent structures, leading to high complication rates. Therefore, skull base lesions in children require an experienced multidisciplinary team to provide optimal care.
Collapse
|
3
|
Reardon T, Turnow M, Elston S, Brown NJ, Koller GM, Sharma S, Kortz MW, Mohyeldin A, Fraser JF. Surgical management of petrous apex cholesteatomas in the pediatric population: A systematic review. Surg Neurol Int 2022; 13:494. [DOI: 10.25259/sni_667_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Cholesteatomas are growths of squamous epithelium that can form inside the middle ear and mastoid cavity and damage nearby structures causing hearing loss when located at the petrous apex. The primary goal of petrous apex cholesteatoma resection is gross total removal with tympanoplasty and canal-wall up or canal-wall down tympanomastoidectomy. At present, there is no definitive surgical approach supported by greater than level 4 evidence in the literature to date.
Methods:
A systematic review was conducted utilizing PubMed, Embase, and Scopus databases. Articles were screened and selected to be reviewed in full text. The articles that met inclusion criteria were reviewed for relevant data. Data analysis, means, and standard deviations were calculated using Microsoft Excel.
Results:
After screening, five articles were included in the systematic review. There were a total of eight pediatric patients with nine total cholesteatomas removed. Conductive hearing loss was the most common (77%) presenting symptom. Perforations were noted in seven ears (86%). Recurrence was noted in 50% of patients with an average recurrence rate of 3.5 years (SD = 1.73). Average length of follow-up was 32.6 months (SD = 21.7). Canal-wall up was the most utilized technique (60%) and there were zero noted surgical complications. Five of the seven (71%) patients that experienced hearing loss from perforation noted improved hearing.
Conclusion:
Due to its rarity, diagnostic evaluation and treatment can vary. Further, multi-institutional investigation is necessary to develop population-level management protocols for pediatric patients affected by petrous apex cholesteatomas.
Collapse
Affiliation(s)
- Taylor Reardon
- Department of Neurosurgery, Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Morgan Turnow
- Department of Neurosurgery, Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Sidney Elston
- Department of Neurosurgery, Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Nolan J. Brown
- Department of Neurological Surgery, University of California, Irvine, California, United States
| | - Gretchen M. Koller
- Department of Neurosurgery, College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, United States
| | - Shelly Sharma
- Department of Neurosurgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, United States
| | - Michael W. Kortz
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Ahmed Mohyeldin
- Department of Neurological Surgery, University of California, Irvine, California, United States
| | - Justin F. Fraser
- Department of Neurosurgery, Neurology, Radiology and Neuroscience, University of Kentucky, Lexington, Kentucky, United States
| |
Collapse
|
4
|
Bako P, Kovacs M, Uzsaly J, Burian A, Bodzai G, Nemeth A, Toth A, Szanyi I, Gerlinger I. Subtotal Petrosectomy and Cochlear Implantation in Children With Chronic Suppurative Otitis Media: A Single Institutional Experience. J Audiol Otol 2022; 26:214-222. [PMID: 36285467 PMCID: PMC9597276 DOI: 10.7874/jao.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review. SUBJECTS AND METHODS SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded. RESULTS The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7-13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively. CONCLUSIONS SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.
Collapse
Affiliation(s)
- Peter Bako
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary,Regenerative Science, Sport and Medicine Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary,Address for correspondence Peter Bako, MD, PhD Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, 2 Munkacsy Street, H-7621 Pécs, Hungary Tel +36-72507312 Fax +36-72312151 E-mail
| | - Marton Kovacs
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Janos Uzsaly
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Andras Burian
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Greta Bodzai
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Adrienn Nemeth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Arnold Toth
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Istvan Szanyi
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Imre Gerlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| |
Collapse
|
5
|
Malina GEK, Heiferman DM, Riedy LN, Szujewski CC, Rezaii EG, Leonetti JP, Anderson DE. Pediatric vestibular schwannomas: case series and a systematic review with meta-analysis. J Neurosurg Pediatr 2020; 26:302-310. [PMID: 32470932 DOI: 10.3171/2020.3.peds19514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sporadic unilateral vestibular schwannomas are rare in the pediatric population. Little has been reported in the literature on the presentation, tumor size, response to surgical treatment, and recurrence rates in these younger patients. The authors' goal was to describe their institutional experience with pediatric sporadic vestibular schwannomas and to conduct a meta-analysis of the existing literature to provide further insight into the presentation, tumor characteristics, and surgical outcomes for these rare tumors to help direct future treatment strategies. METHODS The authors performed a retrospective review of all patients 21 years of age or younger with unilateral vestibular schwannomas and without neurofibromatosis type 2 who underwent resection by the senior authors between 1997 and 2019. A systematic review of the literature and meta-analysis was also performed by entering the search terms "pediatric" and "vestibular schwannoma" or "acoustic neuroma," as well as "sporadic" into PubMed. Presentation, treatment, clinical outcomes, and follow-up were analyzed. RESULTS Fifteen patients were identified at the authors' institution, ranging in age from 12 to 21 years (mean 16.5 years). Common presenting symptoms included hearing loss (87%), headache (40%), vertigo (33%), ataxia (33%), and tinnitus (33%). At the time of surgery, the mean tumor size was 3.4 cm, with four 1-cm tumors. Four patients had residual tumor following their first surgery, 3 (75%) of whom had significant radiographic regrowth that required further treatment. The literature review identified an additional 81 patients from 26 studies with patient-specific clinical data available for analysis. This resulted in a total of 96 reported patients with an overall average age at diagnosis of 12.1 years (range 6-21 years) and an average tumor size of 4.1 cm. CONCLUSIONS Pediatric vestibular schwannomas present similarly to those in adults, although symptoms of mass effect are more common, as these tumors tend to be larger at diagnosis. Some children are found to have small tumors and can be successfully treated surgically. Residual tumors in pediatric patients were found to have a higher rate of regrowth than those in their adult counterparts.
Collapse
Affiliation(s)
| | | | - Loren N Riedy
- Departments of1Neurological Surgery and
- 3Department of Neurobiology, University of Chicago, Illinois
| | - Caroline C Szujewski
- Departments of1Neurological Surgery and
- 3Department of Neurobiology, University of Chicago, Illinois
| | | | - John P Leonetti
- 2Otolaryngology, Loyola University Medical Center, Maywood; and
| | | |
Collapse
|
6
|
James AL. Cholesteatoma in Children: Surgical Technique, Hearing Rehabilitation and Surveillance. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0180-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
7
|
Lateral Skull Base Approaches in Pediatric Skull Base Surgery. J Neurol Surg B Skull Base 2018; 79:47-57. [PMID: 29404241 DOI: 10.1055/s-0038-1624572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Lateral skull base pathology is rare in children. Awareness of the potential for lateral skull base lesions in children is imperative for timely identification and appropriate management. Some of the common presentations and pathologies shall be presented, as well as a variety of approaches that may be utilized to access the lateral skull base in the pediatric patient. Although the lateral skull base approaches utilized in adults may also be considered for management of pediatric lesions, some special considerations given the small developing anatomy need to be kept in mind.
Collapse
|