J Neurol Surg B Skull Base 2020; 81(05): 515-525
DOI: 10.1055/s-0039-1692641
Original Article

Endoscopic Transnasal Skull Base Surgery in Pediatric Patients

1   Department of Neurosurgery, Ankara University, Ankara, Turkey
,
Cem Meco*
2   Department of Otolaryngology, Ankara University, Turkey
3   Department of Otolaryngology, Salzburg Paracelsus Medical University, Salzburg, Austria
,
Suha Beton*
2   Department of Otolaryngology, Ankara University, Turkey
,
Murat Zaimoglu*
1   Department of Neurosurgery, Ankara University, Ankara, Turkey
,
Onur Ozgural*
1   Department of Neurosurgery, Ankara University, Ankara, Turkey
,
Hazan Basak*
2   Department of Otolaryngology, Ankara University, Turkey
,
Melih Bozkurt*
1   Department of Neurosurgery, Ankara University, Ankara, Turkey
,
Agahan Unlu*
1   Department of Neurosurgery, Ankara University, Ankara, Turkey
› Author Affiliations

Abstract

Introduction In pediatric patients, endoscopic transnasal surgery (ETNS) poses challenges because of the small size of the developing skull and narrow endonasal corridors.

Objective This study aimed to evaluate the efficacy of ETNS in children by assessing our experience of endoscopic skull base surgery.

Materials and Methods All pediatric patients (n = 54) who were eligible for surgery using only the endonasal endoscopic approach at our tertiary center between 2012 and 2018 were included in this study. The surgeries were performed simultaneously by an endoscopic skull base team of neurosurgeons and otolaryngologists. Hormonal analyses were conducted before and after surgery in all patients with sellar/parasellar lesions. Patients older than 8 years underwent smell and visual testing.

Results In the 54 patients aged 1 to 17 years who underwent surgery, craniopharyngioma was the most common pathology (29.6%), followed by pituitary adenoma (22.2%). Gross total resection was achieved in 33 (76.7%) of 41 patients who underwent surgery because of the presence of tumors. All visual deficits improved, although one patient sustained olfactory deterioration. Sixteen (29.6%) patients presented with complications such as transient diabetes insipidus and temporary visual loss.

Conclusions Despite anatomy-related challenges in children, adequate results can be achieved with high rates of success, and the functional and anatomical integrity of the developing skull and nose of children can be preserved. In pediatric patients, ETNS is a safe and effective option for addressing various lesions along the skull base.

* These authors contributed equally to this work.




Publication History

Received: 20 January 2019

Accepted: 07 May 2019

Article published online:
18 June 2019

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Fliss DM. Recent advances in pediatric skull base surgery. J Neurol Surg B Skull Base 2018; 79 (01) 1-2
  • 2 Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC. Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 2013; 11 (03) 227-241
  • 3 Kassam A, Thomas AJ, Snyderman C. et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 2007; 106 (2, Suppl): 75-86
  • 4 Khalili S, Palmer JN, Adappa ND. The expanded endonasal approach for the treatment of intracranial skull base disease in the pediatric population. Curr Opin Otolaryngol Head Neck Surg 2015; 23 (01) 65-70
  • 5 Locatelli D, Massimi L, Rigante M. et al. Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 2010; 74 (11) 1298-1302
  • 6 Zhan R, Xin T, Li X, Li W, Li X. Endonasal endoscopic transsphenoidal approach to lesions of the sellar region in pediatric patients. J Craniofac Surg 2015; 26 (06) 1818-1822
  • 7 Giovannetti F, Mussa F, Priore P. et al. Endoscopic endonasal skull base surgery in pediatric patients. A single center experience. J Craniomaxillofac Surg 2018; 46 (12) 2017-2021
  • 8 Banu MA, Rathman A, Patel KS. et al. Corridor-based endonasal endoscopic surgery for pediatric skull base pathology with detailed radioanatomic measurements. Neurosurgery 2014; 10 (Suppl. 02) 273-293 , discussion 293
  • 9 Holzmann D, Bozinov O, Krayenbühl N. Is there a place for the endoscope in skull base surgery in children less than 5 years?. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (02) 133-139
  • 10 Youssef CA, Smotherman CR, Kraemer DF, Aldana PR. Predicting the limits of the endoscopic endonasal approach in children: a radiological anatomical study. J Neurosurg Pediatr 2016; 17 (04) 510-515
  • 11 Tatreau JR, Patel MR, Shah RN. et al. Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients. Laryngoscope 2010; 120 (09) 1730-1737
  • 12 Kahilogullari G, Meco C, Beton S, Zaimoglu M, Basak H, Unlu A. Endoscopic endonasal skull base surgery for 38 pediatric cases: Ankara University experience. J Neurol Surg B Skull Base 2017; 78 (01) S1-S156
  • 13 Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH. Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 2013; 119 (05) 1194-1207
  • 14 Bakhsheshian J, Jin DL, Chang KE. et al. Risk factors associated with the surgical management of craniopharyngiomas in pediatric patients: analysis of 1961 patients from a national registry database. Neurosurg Focus 2016; 41 (06) E8
  • 15 Jane Jr JA, Prevedello DM, Alden TD, Laws Jr ER. The transsphenoidal resection of pediatric craniopharyngiomas: a case series. J Neurosurg Pediatr 2010; 5 (01) 49-60
  • 16 Pandey P, Ojha BK, Mahapatra AK. Pediatric pituitary adenoma: a series of 42 patients. J Clin Neurosci 2005; 12 (02) 124-127
  • 17 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal versus open repair of anterior skull base CSF leak, meningocele, and encephalocele: a systematic review of outcomes. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (04) 239-250
  • 18 Elliott RE, Jane Jr JA, Wisoff JH. Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 2011; 69 (03) 630-643 , discussion 643
  • 19 Di Rocco F, Couloigner V, Dastoli P, Sainte-Rose C, Zerah M, Roger G. Treatment of anterior skull base defects by a transnasal endoscopic approach in children. J Neurosurg Pediatr 2010; 6 (05) 459-463
  • 20 Massimi L, Rigante M, D'Angelo L. et al. Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgery. Acta Neurochir (Wien) 2011; 153 (04) 843-849
  • 21 Rigante M, Massimi L, Parrilla C. et al. Endoscopic transsphenoidal approach versus microscopic approach in children. Int J Pediatr Otorhinolaryngol 2011; 75 (09) 1132-1136
  • 22 Meco C, Oberascher G. Comprehensive algorithm for skull base dural lesion and cerebrospinal fluid fistula diagnosis. Laryngoscope 2004; 114 (06) 991-999
  • 23 Meco C, Arrer E, Oberascher G. Efficacy of cerebrospinal fluid fistula repair: sensitive quality control using the beta-trace protein test. Am J Rhinol 2007; 21 (06) 729-736
  • 24 Yakar F, Doğan İ, Meco C, Heper AO, Kahilogullari G. Sellar embryonal tumor: a case report and review of the literature. Asian J Neurosurg 2018; 13 (04) 1197-1201
  • 25 Kahilogullari G, Yakar F, Bayatli E, Erden E, Meco C, Unlu A. Endoscopic removal of a suprasellar dermoid cyst in a pediatric patient: a case report and review of the literature. Childs Nerv Syst 2018; 34 (08) 1583-1587
  • 26 Kahilogullari G, Meco C, Zaimoglu M. et al. Pneumocephalus after endoscopic odontoidectomy in a pediatric patient: the lesson learned. Childs Nerv Syst 2015; 31 (09) 1595-1599
  • 27 Ben-Ari O, Wengier A, Ringel B. et al. Nasoseptal flap for skull base reconstruction in children. J Neurol Surg B Skull Base 2018; 79 (01) 37-41
  • 28 Ma J, Huang Q, Li X. et al. Endoscopic transnasal repair of cerebrospinal fluid leaks with and without an encephalocele in pediatric patients: from infants to children. Childs Nerv Syst 2015; 31 (09) 1493-1498
  • 29 Stapleton AL, Tyler-Kabara EC, Gardner PA, Snyderman CH, Wang EW. Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery. Int J Pediatr Otorhinolaryngol 2017; 93: 163-166
  • 30 Gump WC. Endoscopic endonasal repair of congenital defects of anterior skull base: developmental considerations and surgical outcomes. J Neurol Surg B Skull Base 2015; 76 (04) 291-295
  • 31 Ghosh A, Hatten K, Learned KO. et al. Pediatric nasoseptal flap reconstruction for suprasellar approaches. Laryngoscope 2015; 125 (11) 2451-2456
  • 32 Wasserzug O, DeRowe A, Ringel B, Fishman G, Fliss DM. Open approaches to the anterior skull base in children: review of the literature. J Neurol Surg B Skull Base 2018; 79 (01) 42-46
  • 33 Duek I, Pener-Tessler A, Yanko-Arzi R. et al. Skull base reconstruction in the pediatric patient. J Neurol Surg B Skull Base 2018; 79 (01) 81-90
  • 34 Chen G, Zhang Q, Ling F. An endoscopic endonasal approach for the surgical repair of transsphenoidal cephalocele in children. J Clin Neurosci 2011; 18 (05) 723-724
  • 35 Keshri AK, Shah SR, Patadia SD, Sahu RN, Behari S. Transnasal endoscopic repair of pediatric meningoencephalocele. J Pediatr Neurosci 2016; 11 (01) 42-45
  • 36 Zeinalizadeh M, Sadrehosseini SM, Habibi Z, Nejat F, Silva HB, Singh H. Endonasal management of pediatric congenital transsphenoidal encephaloceles: nuances of a modified reconstruction technique. Technical note and report of 3 cases. J Neurosurg Pediatr 2017; 19 (03) 312-318
  • 37 Marfatia HK, Parelkar KA, Chakraborty A, Mishra S. Pediatric meningoencephaloceles endoscopic repair: our experience. Allergy Rhinol (Providence) 2018; 9: 2152656718802408
  • 38 Stapleton AL, Tyler-Kabara EC, Gardner PA, Snyderman CH. Endoscopic endonasal surgery for benign fibro-osseous lesions of the pediatric skull base. Laryngoscope 2015; 125 (09) 2199-2203
  • 39 Elangovan C, Singh SP, Gardner P. et al. Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors. J Neurosurg Pediatr 2016; 17 (02) 147-155
  • 40 Kahilogullari G, Beton S, Al-Beyati ES. et al. Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. Laryngoscope 2013; 123 (09) 2112-2119
  • 41 Stefko ST, Snyderman C, Fernandez-Miranda J. et al. Visual outcomes after endoscopic endonasal approach for craniopharyngioma: the Pittsburgh experience. J Neurol Surg B Skull Base 2016; 77 (04) 326-332
  • 42 Patel VS, Thamboo A, Quon J. et al. Outcomes after endoscopic endonasal resection of craniopharyngiomas in the pediatric population. World Neurosurg 2017; 108: 6-14
  • 43 Fredes F, Undurraga G, Rojas P. et al. Visual outcomes after pituitary surgery in patients presenting with preoperative visual deficits. J Neurol Surg B Skull Base 2017; 78 (06) 461-465
  • 44 Tan SH, Ganesan D, Prepageran N, Waran V. A minimally invasive endoscopic transnasal approach to the craniovertebral junction in the paediatric population. Eur Arch Otorhinolaryngol 2014; 271 (11) 3101-3105