The Use of a Peel-Away Catheter as a Working Channel in Pediatric Endoscopic Endonasal Surgery: A Technical Note

Objective: Pediatric skull base surgery is challenging due to the need of working through small corridors and reducing the amount of intraoperative blood losses. Moreover, the still-growing skull base is crucial to the right development of the whole skull. The authors aim to present a novel surgical application of a peel-away catheter positioned in the nose as a working channel and, therefore, to avoid unintentional traumatic injuries to the nasal structures during pediatric endoscopic endonasal skull base surgeries.

Methods: The authors present an exemplificative case describing the application of a peel-away catheter (Introducer Sheath, 4.7 mm, Medtronic, Inc., Minneapolis, Minnesota, United States) to create a surgical working channel in endoscopic endonasal approach (EEA).

Results: A 3-year-old baby harboring a sellar and sovra-sellar lesion underwent an EEA. After performing a posterior septectomy and bilateral sphenoidotomies a peel-away catheter was positioned in the left nostril and fixed in place with two 2–0 silk stiches. Afterwards, the tumor was removed by a “four hands–four eyes” technique. The surgical closure was performed with a gasket seal modified technique. There was no need of post-operative nasal packing and the patient had a great recovery and good nasal outcome.

Conclusion: The initial experience with the peel-away catheter in endoscopic endonasal procedure is promising. It could significantly reduce any unintentional damages to the nasal mucosa due to the continuous back and forth insertion of instruments. Further studies are required to confirm its clinical impact in larger and prospective skull base patients series (both pediatric and adults).