Endoscopic Skull Base Approach for Pediatric Fibrous Dysplasia: Usefulness of the Simultaneous Combination of Craniotomy

The usefulness of endoscopic endonasal skull base surgery (EES) and concurrent craniotomy was discussed in our three cases of experiences of fibrous dysplasia (FD). Case 1: Eight years-old girl was presented with progression of visual deterioration. Bilateral optic canal was narrowed by FD in sphenoid bone. EES was performed to reduce the volume around the optic canal but restenosis was observed in three years. ESS was performed again and opened the optic canal bilaterally. Her visual field was expanded after the 2nd surgery although the visual acuity was not improved. Case 2: Thirteen year-old girl was presented with progressive visual loss of her right eye. FD was extended in the right sphenoid and temporal bone to the nasal cavity. The mass was removed by EES and concurrent craniotomy and optic canal was decompressed almost the entire circumference via trans-cranial and trans- sphenoidal routes. Her visual acuity was improved postoperatively. Case 3: Twelve year-old girl was presented with exophthalmos and bilateral visual loss. Huge FD was observed in the nasal cavity. After embolization of spheno-palatine artery, majority of the mass was removed by combined EES and craniotomy. Optic canal was decompressed almost entirely and her visual field defect was improved. Simultaneous combination of EES and craniotomy for skull base FD was more effective than each single method in terms of entire optic canal decompression, orientation of each approach and control of intraoperative bleeding. Functional cooperation of otolaryngologist and neurosurgeon was important.