Abstract:
Minimally invasive (MIS) approaches to neurosurgical diseases continue to increase in popularity due to their association with decreased infection risk, shorter recovery time, and improved cosmesis. Cosmesis and lower morbidity are especially important for pediatric patients. The supraorbital keyhole craniotomy (SOKC) is one MIS approach shown to be effective for both neoplastic and vascular pathologies in pediatric patients. However, it is limited data on its use in pediatric trauma patients. Two cases employing SOKC in pediatric trauma patients are presented here along with a systematic review of the literature. We queried PubMed, Scopus, and Web of Science databases from inception to August 2022 using the Boolean search term: (supraorbital OR eyebrow OR transeyebrow OR suprabrow OR superciliary OR supraciliary) AND (craniotomy OR approach OR keyhole OR procedure) AND (pediatric OR children OR child OR young) AND \"trauma\". Studies that discussed the use of an SOKC in a pediatric patient having sustained trauma to the frontal calvarium and/or anterior fossa/sellar region of the skull base were included. Details were extracted on patient demographics, trauma etiology, endoscope use, and surgical and cosmetic outcomes. We identified 89 unique studies, of which four met inclusion criteria. Thirteen total cases were represented. Age and sex were reported for 12 patients, 25% of whom were male; the mean age was 7.5 years (range: 3-16). Pathologies included acute epidural hematoma (9), orbital roof fracture with dural tear (1), blowout fracture of the medial wall of the frontal sinus with supraorbital rim fracture (1), and compound skull fracture (1). Twelve patients were treated with a conventional operating microscope, while one underwent endoscope-assisted surgery. Only one significant complication (recurrent epidural hematoma) was reported. There were no reported cosmetic complications. The MIS SOKC approach is a reasonable option for select anterior skull base trauma in the pediatric population. This approach has been used previously for successful frontal epidural hematoma evacuation, which is often treated by a large craniotomy. Further study is merited.
摘要:
神经外科疾病的微创(MIS)方法由于与感染风险降低有关,因此越来越受欢迎。更短的恢复时间,和改进的宇宙。对于儿科患者来说,Cossesis和较低的发病率尤为重要。眶上锁孔开颅术(SOKC)是一种MIS方法,对儿科患者的肿瘤和血管病变均有效。然而,关于其在小儿创伤患者中使用的数据有限。本文介绍了两例在小儿创伤患者中使用SOKC的病例,并对文献进行了系统回顾。我们询问PubMed,Scopus,和WebofScience数据库从开始到2022年8月使用布尔搜索词:(眶上或眉毛或跨眉或上眉或上睫状)和(开颅手术或入路或锁眼或手术)和(小儿或儿童或儿童或儿童)和“创伤”。包括讨论了SOKC在额叶颅骨和/或颅底前窝/鞍区遭受持续创伤的儿科患者中使用的研究。细节是根据患者的人口统计学提取的,创伤的病因,内窥镜使用,以及手术和美容结果。我们确定了89项独特的研究,其中四人符合纳入标准。共有13例。报告了12例患者的年龄和性别,其中25%为男性;平均年龄为7.5岁(范围:3-16)。病理包括急性硬膜外血肿(9),眶顶骨折伴硬膜撕裂(1),额窦内壁爆裂性骨折伴眶上缘骨折(1),和复合颅骨骨折(1)。12例患者接受常规手术显微镜治疗,其中一人接受了内窥镜辅助手术。仅报告了一种重大并发症(复发性硬膜外血肿)。没有报告的美容并发症。MISSOKC方法是儿科人群中选择前颅底外伤的合理选择。这种方法以前曾用于成功的额硬膜外血肿清除术,通常通过大型开颅手术治疗。值得进一步研究。