Posttreatment Rhinosinusitis following Endoscopic Resection of Pediatric Craniopharyngioma

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Tong, Charles C., Edward C. Kuan, Seerat K. Poonia, Michael A. Kohanski, Justina L. Lambert, Phillip B. Storm, James N. Palmer, and Nithin D. Adappa


Background The endoscopic endonasal approach has been utilized in the resection of craniopharyngiomas in the pediatric population. There are unique challenges to these patients in the postoperative setting, including patient compliance with nasal saline lavage and debridements, and smaller airway that increases propensity toward scarring. Given these challenges, we evaluated the incidence of posttreatment sinusitis based on the number of infections requiring antibiotics and imaging findings.

Methods A single-center, retrospective review of pediatric patients undergoing endoscopic transsphenoidal resection of craniopharyngiomas between 2009 and 2015 was performed. Demographic and clinicopathologic data, pre- and postoperative imaging and the need for antibiotics were analyzed. Paired two-tailed t-test was used to examine mean difference between the groups.

Results Twenty-one patients (17 males and 4 females) were identified with 24 cases available for analysis. Mean age was 9.4 years, with a median follow-up of 20 months. All patients underwent the endoscopic endonasal approach for resection of craniopharyngioma. All cases were reconstructed with a nasoseptal flap as the mucosal surface. Postoperatively, eight (24.2%) patients had clinically significant sinus disease requiring antibiotic treatment. Five (20.8%) patients had evidence of mucosal thickening on follow-up imaging, and no radiographic disease was found in three (12.5%) patients. The median time to postoperative MRI was 6.4 and 24.8 months. The mean Lund–Mackay’s scores at preoperative, 6, and 24 months were 1, 2.94, and 2.25, respectively. A significant difference in the Lund–Mackay’s scores was detected between preoperative and 6 months (t(17) = −2.16, p = 0.045). No patients required a return to the operating room for revision sinus surgery.

Conclusion Endoscopic skull base approaches have gained popularity in the treatment of pediatric craniopharyngiomas. Given the unique challenges in these patients, we evaluated our series of posttreatment rhinosinusitis and found that transient episodes of rhinosinusitis can be seen up to 6 months postoperatively, generally with resolution thereafter.