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Skull base approaches in the pediatric population
Ziv Gil1, Shlomo Constantini, Sergey Spektor
1Skull Base Surgery Unit and the Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv 64239, Israel. ziv@dot.co.il
Insights
Pediatric skull base tumor surgery using conventional techniques is safe and feasible, with low complication and mortality rates. Long-term cosmetic outcomes are excellent, showing negligible impact on craniofacial development.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Craniofacial Surgery
Background:
- Skull base tumors present unique challenges in pediatric patients.
- Surgical, oncologic, and developmental outcomes require careful evaluation.
Purpose of the Study:
- To assess the surgical, oncologic, and developmental results of pediatric skull base tumor extirpation.
- To evaluate the safety and efficacy of conventional surgical techniques in this population.
Main Methods:
- Retrospective analysis of 67 pediatric patients (0.5-18 years) undergoing skull base tumor surgery over 6 years.
- Tumor classification (benign/malignant), location (anterior, lateral, posterior), and surgical approaches (subcranial, transfacial, subfrontal, combined) were recorded.
- Adjuvant therapy and postoperative follow-up (3-60 months) were documented.
Main Results:
- No severe postoperative complications or perioperative mortality were observed.
- 80% of patients were alive and well at 2.5 years post-surgery.
- The subcranial approach demonstrated no adverse cosmetic impact on craniofacial development.
Conclusions:
- Extirpation of skull base tumors in children using conventional surgical methods is feasible and safe.
- Pediatric patients exhibit lower complication and mortality rates compared to adults.
- The subcranial approach yields negligible long-term cosmetic effects.
Background:
This study aimed to examine the surgical, oncologic, and developmental results of infants and children undergoing extirpation of skull base tumors.
Methods:
Sixty-seven children aged 0.5 to 18 years (mean, 11 years) who were operated on during a 6-year period made up the study cohort. Eighteen cases (27%) involved malignant tumors, and 49 (73%) involved benign tumors. The most common benign tumors were craniopharyngioma (n = 10) and juvenile nasopharyngeal angiofibroma (n = 8). The most common malignant tumor was sarcoma (n = 5). Thirty-six tumors (55%) involved the anterior skull base, and the rest involved the lateral (n = 24) and posterior (n = 7) skull base. Subcranial, transfacial, and subfrontal approaches were used for extirpation of anterior skull base tumors. Voluminous or malignant tumors were excised by use of combined approaches (subcranial-transfacial, subcranial-degloving, or pterional-degloving). Twenty-two children underwent adjuvant therapy (chemotherapy, radiation, or both). Postoperative follow-up was 3 to 60 months.
Results:
No severe postoperative complications (ie, meningitis, cerebrospinal fluid leak, tension pneumocephalus) and no perioperative mortality occurred. Two and a half years later, 54 of the children (80%) are alive and well. Five children, two with optic glioma and one each with squamous cell carcinoma, ependymoma, and germinoma, have died of their disease. The subcranial approach had no cosmetic impact on the craniofacial development of the patients.
Conclusion:
The extirpation of skull base tumors by use of conventional surgical techniques is feasible and safe among infants and children. The complication and mortality rates are lower than those in adults. The long-term cosmetic effect of the subcranial approach is negligible.
