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Nistal D, Lee A, Ruzevick J. Pediatric Orbital and Skull Base Pathology. Oral Maxillofac Surg Clin North Am 2024; 36:333-342. [PMID: 38522979 DOI: 10.1016/j.coms.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Pediatric orbital and skull base pathologies encompass a spectrum of inflammatory, sporadic, syndromic, and neoplastic processes that require a broad and complex clinical approach for both medical and surgical treatment. Given their complexity and often multicompartment involvement, a multidisciplinary approach for diagnosis, patient and family counseling, and ultimately treatment provides the best patient satisfaction and clinical outcomes. Advances in minimally invasive surgical approaches, including endoscopic endonasal and transorbital approaches allows for more targeted surgical approaches through smaller corridors beyond more classic transcranial or transracial approaches.
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Affiliation(s)
- Dominic Nistal
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA
| | - Amy Lee
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Jacob Ruzevick
- Department of Neurological Surgery, University of Washington, 1959 Northeast Pacific Street, Box 356470, Seattle, WA 98195, USA; Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
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Salge-Arrieta FJ, Vior-Fernández C, Lee P, Reguero-Callejas ME, Pian-Arias HG, Martínez-San Millán JS, Carrasco-Moro R. Giant fronto-spheno-orbitary juvenile psammomatoid ossifying fibroma: Case report and literature review. Childs Nerv Syst 2024; 40:939-945. [PMID: 38038744 DOI: 10.1007/s00381-023-06206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
Juvenile psammomatoid ossifying fibroma (JPOF) is an osteofibrous neoplasm that originates in the craniofacial skeleton typically during the first three decades of life. JPOFs usually involve the orbit, paranasal sinuses or the jaws. Extensive involvement of the anterior cranial base with compromised visual function is a rare phenomenon. In such clinical context, a definite diagnosis can only be made on the basis of histopathological findings, given the absence of pathognomonic radiological features. Despite being considered a benign entity, JPOFs present a locally aggressive behavior. Therefore, these neoplasms must be included in the differential diagnosis in every patient harboring a skull base osteofibrous lesion, and, once diagnosed, gross total surgical removal should be attempted. In this study, we present our experience in the diagnosis and treatment of a patient diagnosed with a giant JPOF involving the cranial base.
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Affiliation(s)
| | | | - Paul Lee
- Arkansas Neuroscience Institute, Sherwood, AR, USA
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Azab MA. Ossifying fibroma of the ethmoid and sphenoid sinuses: A report of a rare case and literature review. Surg Neurol Int 2024; 15:38. [PMID: 38468684 PMCID: PMC10927173 DOI: 10.25259/sni_182_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 01/10/2024] [Indexed: 03/13/2024] Open
Abstract
Background Fibro-osseous lesions include a variety of bone lesions with different clinical and histopathological features. Case Description We report a case of cemento-ossifying lesion involving the left ethmoid and sphenoid sinus in a 17-year-old male patient. Computed tomography showed an expansile hyperdense lesion with sclerosed peripheral mantle epicentered on the left ethmoid and sphenoid sinus and extending into the left nasal cavity. Magnetic resonance imaging was done for preoperative planning. Transnasal endoscopic resection was performed and histopathological examination confirmed the diagnosis of ossifying fibroma (OF). Conclusion Involvement of the ethmoid sinus with OF is a rare condition; therefore, we examined the literature for similar cases to highlight the possible clinical presentation and management. Endoscopic management is a safe, effective approach with a low rate of complications.
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Pediatric Benign Fibro-Osseous Lesions of the Nose and Paranasal Sinuses: A Tertiary Hospital Experience. Int J Otolaryngol 2022; 2022:1608015. [PMID: 36060197 PMCID: PMC9436620 DOI: 10.1155/2022/1608015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Pediatric benign fibro-osseous lesions of the nose and paranasal sinuses are considered rare neoplastic entities. These fibro-osseous lesions are difficult to accomplish owing to the multifaceted anatomy of the skull base in addition to the closeness to neurovascular configurations. Objective The study aimed to study different clinical presentations, radiological manifestations, surgical management, and consequences of different benign fibro-osseous lesions in the pediatric age groups. Methods and Settings. This is a case series study of a single-center experience. Results Four different cases were presented and discussed (osteoma, fibrous dysplasia, and ossifying fibroma. Conclusion We reported four different cases of osteoma, ossifying fibroma, and fibrous dysplasia. All of these cases were managed endoscopically with no postoperative complications. Endoscopic management is considered highly effective with reduced morbidity. Preoperative radiographic studies are highly essential for diagnosis and operative planning.
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Kim M, Otten M, Kazim M, Gudis DA. Frontal osteoplastic flap without frontal sinus obliteration for orbital roof decompression. Orbit 2020; 40:145-149. [PMID: 32340509 DOI: 10.1080/01676830.2020.1757126] [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: 10/24/2022]
Abstract
Purpose: We describe a novel surgical approach for bilateral orbital roof decompression using a frontal osteoplastic flap without frontal sinus obliteration. This technique utilizes a combined external and endonasal endoscopic approach for wide exposure to the orbital roof bilaterally. We demonstrate this technique for the resection of a massive frontal fibrous dysplasia lesion in a healthy male with bilateral orbital roof involvement. The endonasal endoscopic portion of the technique includes a Draf III frontal sinusotomy (endoscopic modified Lothrop procedure) which precludes the need for frontal sinus obliteration, restores normal frontal sinus function, and allows for postoperative endoscopic surveillance. Methods: Report of novel surgical technique with video demonstration. Results: This technique for orbital roof decompression allows for removal of a frontal lesion, wide decompression of the bilateral orbital roof, and post-operative endonasal endoscopic surveillance of the cavity. The patient in whom we demonstrate this technique had complete resolution of his orbital symptoms and minimal residual fibrous dysplasia postoperatively. Conclusion: Bilateral orbital roof decompression for frontal lesions can be performed safely and effectively with a frontal osteoplastic flap without frontal sinus obliteration, restoring normal orbital and sinus function.
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Affiliation(s)
- Matthew Kim
- Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - Marc Otten
- Department of Neurological Surgery, The Neurological Institute of New York, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - Michael Kazim
- Oculoplastic and Orbital Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - David A Gudis
- Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
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Riley CA, Soneru CP, Overdevest JB, Otten ML, Gudis DA. Pediatric sinonasal and skull base lesions. World J Otorhinolaryngol Head Neck Surg 2020; 6:118-124. [PMID: 32596657 PMCID: PMC7296510 DOI: 10.1016/j.wjorl.2020.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/18/2020] [Indexed: 12/13/2022] Open
Abstract
Pediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.
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Affiliation(s)
- Charles A Riley
- Department of Otolaryngology, Head and Neck Surgery, New York Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Christian P Soneru
- Department of Otolaryngology, Head and Neck Surgery, New York Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology, Head and Neck Surgery, New York Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Marc L Otten
- Department of Neurological Surgery, New York Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology, Head and Neck Surgery, New York Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
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London NR, Rangel GG, Walz PC. The expanded endonasal approach in pediatric skull base surgery: A review. Laryngoscope Investig Otolaryngol 2020; 5:313-325. [PMID: 32337363 PMCID: PMC7178460 DOI: 10.1002/lio2.369] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Surgery of the pediatric skull base has multiple unique challenges and has seen recent rapid advances. The objective of this review is to assess key issues in pediatric skull base surgery (SBS), including anatomic limitations, surgical approaches, reconstruction techniques, postoperative care, complications, and outcomes. DATA SOURCES PubMed literature review. REVIEW METHODS A review of the literature was conducted to assess the challenges, recent advances, and reported outcomes in pediatric SBS. RESULTS The pediatric skull base presents multiple anatomic challenges, including variable patterns of pneumatization, narrow piriform aperture width, and narrow intercarotid distance at the level of the cavernous sinus but not the superior clivus. These issues may be particularly challenging in patients less than 2 years of age. Endoscopic endonasal approaches in the sagittal and coronal plane have been applied to the pediatric skull base while open approaches may still be necessary in the setting of extensive intracranial or orbital disease, as well as disease lateral to critical neurovascular structures. While the nasoseptal flap was initially called into question for pediatric cases, it has been shown through multiple reports to be a feasible and robust reconstructive option. Complications and outcomes often depend upon the pathology. In children, response to noxious stimuli, ability to avoid Valsalva, and adherence to nasal precautions is variable. The use of lumbar drains is more common in pediatric than adult patients. CONCLUSION While the pediatric skull base presents unique challenges, outcomes data support that endoscopic endonasal approaches are a pertinent surgical technique in appropriately selected patients. LEVEL OF EVIDENCE 3a.
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Affiliation(s)
- Nyall R. London
- Otolaryngology‐Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
- Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
- National Institute on Deafness and Other Communication DisordersNIHBethesdaMarylandUSA
| | - Gustavo G. Rangel
- Otolaryngology‐Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
- Pediatric Otolaryngology‐Head and Neck SurgeryNationwide Children's HospitalColumbusOhioUSA
| | - Patrick C. Walz
- Otolaryngology‐Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
- Pediatric Otolaryngology‐Head and Neck SurgeryNationwide Children's HospitalColumbusOhioUSA
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Utilization of contrast-enhanced ultrasound in the evaluation of craniofacial osseous lesions: A case report. Clin Imaging 2019; 60:5-9. [PMID: 31864200 DOI: 10.1016/j.clinimag.2019.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/09/2019] [Accepted: 10/21/2019] [Indexed: 02/01/2023]
Abstract
A 14-year-old boy undergoing brain MRI had an incidental avidly enhancing lobulated lesion in the left superolateral orbital rim with associated cortical erosion. Apart from Contrast-enhanced Magnetic Resonance Imaging (MRI), and Computed Tomography (CT), Contrast-Enhanced Ultrasound (CEUS) was obtained prior to a biopsy. It provided additional information about the microvasculature and an orbital biopsy was subsequently performed through an upper eyelid crease incision with minimal blood loss and no postoperative complications. Histopathological examination revealed features which were compatible with the diagnosis of LCH. The authors propose that CEUS may be considered as an adjunct and possibly alternative imaging modality for the evaluation of craniofacial osseous lesions, especially in the orbital region (due to the known radio-sensitivity of the eyes) and in pediatric patients, to minimize the risk of ionizing-radiation exposure.
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Ahmed AA, Vundamati D, Farooqi M, Repnikova E, Zinkus T, Hetherington M, Paulson L. Next-Generation Sequencing in the Diagnosis of Rare Pediatric Sinonasal Tumors. EAR, NOSE & THROAT JOURNAL 2019; 100:NP263-NP268. [PMID: 31550935 DOI: 10.1177/0145561319863371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of desmoid fibromatosis or other spindle cell tumors in the sinonasal region is very rare in children and needs to be thoroughly confirmed with immunohistochemical and/or molecular tests. We report 2 patients with such rare tumors and describe the use of next-generation sequencing in their evaluation. A 3-year-old female had a 4.4-cm midline nasal cavity mass involving the bony septum and extending into the base of the skull bilaterally. The moderate cellular fibroblastic proliferation revealed areas of thick keloid-like collagen bands and other areas with myxoid edematous stroma. Deep targeted sequencing identified a novel G34V mutation in the CTNNB1 gene consistent with desmoid fibromatosis. An 11-month-old male infant presented with a right nasal mass that extended through the cribriform plate into the anterior cranial fossa and involved the right ethmoid sinus and adjacent right orbit. Histology revealed an infiltrative atypical fibrous proliferation with focal calcifications that was negative for CTNNB1 and GNAS mutations. A novel RET E511K variant was identified in the tumor and later was also found in the germline and hence rendered of unknown significance. Both cases highlight the utility of next-generation sequencing in the evaluation of pediatric sinonasal spindle cell tumors that may have overlapping pathologic features. Reporting of rare or novel variants in tumor-only sequencing should be cautiously evaluated in children and pairing with germline sequencing may be needed to avoid the pitfall of assigning uncommon variants.
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Affiliation(s)
- Atif A Ahmed
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Divya Vundamati
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Midhat Farooqi
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Elena Repnikova
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Timothy Zinkus
- Department of Radiology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Maxine Hetherington
- Department of Pediatrics Hematology-Oncology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Lorien Paulson
- Department of Surgery, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
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Management of Pediatric Sinonasal and Skull Base Lesions. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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