• Javan Nation, Alexander J Schupper, Adam Deconde, and Michael Levy.
• Department of Surgery, Division of Otolaryngology, Head and Neck Surgery University of California San Diego, Division of Pediatric Rady Children's Hospital San Diego, USA; University of California San Diego School of Medicine, La Jolla, CA, USA.
• Int. J. Pediatr. Otorhinolaryngol. 2019 Apr 1; 119: 22-26.

IntroductionThe 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.MethodsA 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.ResultsThirty-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.ConclusionIn 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.Copyright © 2019. Published by Elsevier B.V.

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