Endoscopic Endonasal Skull Base Surgery in the Pediatric Population

Introduction: The use of endoscopic endonasal approaches (EEAs) for skull base pathologies in the pediatric population has been facilitated by improvements in visualization and image guidance, as well as by miniaturization of the instruments. These technological advances have allowed us to implement minimally invasive EEAs in treating various pathophysiologies in the smaller confines of pediatric patients by improving navigation through their unaerated sinuses.

Methods: We conducted a retrospective chart and imaging review of 134 pediatric patients who underwent surgeries with EEAs at our institution since July 1999.

Results: A total of 172 EEAs were performed for bony abnormalities in 21 patients and for skull base tumors in 113. Eighty-five patients (63.4%) were male and the average age at the time of surgery was 12.7 years (range, 2.3–17.9 years). Bony abnormalities included skull base defects (n = 12), basilar invaginations (n = 4), optic nerve compressions (n = 3), and trauma (n = 2); preexisting neurological dysfunction resolved in 12 patients (57.1%), improved in 7 (33.3%), and remained unchanged in 2 (9.5%).

Skull base tumors included angiofibromas (n = 24), craniopharyngiomas (n = 16), Rathke's cleft cysts (n = 12), pituitary adenomas (n = 11), chordomas/chondrosarcomas (n = 10), dermoid/epidermoid tumors (n = 9), and 31 other pathologies. In total, 19 tumors were malignant (14.5%). Fifty-four lesions were solely extradural, and 59 were intradural or intradurally extended. Gross total resection was achieved in 15 angiofibromas (65.2%), 9 craniopharyngiomas (56.3%), 8 Rathke's cleft cysts (72.7%), 7 pituitary adenomas (70%), 5 chordomas/chondrosarcomas (50%), 6 dermoids/epidermoids (75%), and in 9 other pathologies (29%).

Sixteen patients (12.4%) showed tumor recurrence and underwent reoperation. Fifteen patients received adjuvant radiotherapy, and 5 received chemotherapy. Complications included CSF leak in 19 cases (14%), meningitis in 6 (4.5%), transient DI in 8 patients (6.0%), and permanent DI in 11 (8.2%). Eight patients (6.0%) had temporary cranial nerve palsies; in three (2.2%), the palsy became permanent. The mean follow-up time was 22.7 months (range, 1–122 months); five patients were lost to follow-up.

Conclusions: In our cohort, EEAs have proved a safe and feasible surgical technique for the management of a variety of pediatric skull base pathologies. When appropriately indicated, EEAs may allow achieving optimal outcomes in the pediatric population.