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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Skull base surgery for tumors in children: long-term clinical and functional outcome
Caroline Hayhurst1, Dawn Williams, Jawad Yousaf
1Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom. carolinehayhurst@hotmail.com
Insights
Pediatric skull base surgery is safe and effective, offering good long-term tumor control and functional outcomes. Complex procedures are well-tolerated by children, with minimal morbidity when maximal safe resection is combined with adjuvant therapy.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Craniofacial Surgery
Background:
- Skull base tumors in children are rare and necessitate complex surgical approaches.
- These approaches carry risks of morbidity to the developing craniofacial skeleton and tumor-related complications.
- Limited data exists on the long-term clinical and functional outcomes following pediatric skull base surgery.
Purpose of the Study:
- To report long-term clinical and functional outcomes in children undergoing multidisciplinary skull base surgery for tumors.
- To evaluate the safety and efficacy of complex skull base approaches in a pediatric population.
- To assess tumor control rates and surgical morbidity in pediatric skull base tumor resection.
Main Methods:
- Retrospective analysis of pediatric patients (1998-2008) undergoing skull base surgery for various lesions (excluding craniopharyngioma, pituitary tumors, optic glioma).
- Data collected included histology, surgical morbidity, hospital stay, progression-free survival, and adjuvant therapy.
- Long-term functional and cognitive outcomes were prospectively assessed using the Late Effects Severity Score (LESS).
Main Results:
- Twenty-three children underwent surgery with a median follow-up of 60 months.
- Complete resection was achieved in 52% of patients; 57% had benign histology.
- Low rates of surgical complications (e.g., CSF leakage 9%, meningitis 9%) and residual neurological deficit (9%) were observed. Most survivors had good functional outcomes (LESS ≤ 3).
Conclusions:
- Children tolerate complex skull base procedures well.
- Maximal safe resection combined with adjuvant therapy leads to good long-term tumor control and functional outcomes.
- Pediatric skull base surgery demonstrates minimal surgical-related morbidity when performed in a multidisciplinary setting.
Object:
Skull base tumors in children are rare but require complex approaches with potential morbidity to the developing craniofacial skeleton, in addition to tumor-related morbidity. Reports of long-term clinical and functional outcome following skull base approaches in children are scarce. The authors report long-term outcome in children with tumors undergoing multidisciplinary skull base surgery.
Methods:
A retrospective analysis was undertaken of children undergoing surgery at a single institution between 1998 and 2008 for benign and malignant lesions of the anterior, middle, or posterior cranial base. Patients with craniopharyngioma, pituitary tumors, and optic glioma were excluded. Histology, surgical morbidity, length of hospital stay, progression-free survival, and adjuvant therapy were recorded. Functional and cognitive outcome was assessed prospectively using the Late Effects Severity Score (LESS).
Results:
Twenty-three children ranging in age from 13 months to 15 years underwent skull base approaches for resection of tumors during the study period. The median follow-up duration was 60 months. Tumor types included meningioma, schwannoma, rhabdomyosarcoma, neuroblastoma, angiofibroma, and chordoma. Complete resection was achieved in 12 patients (52%). Thirteen patients (57%) had benign histology. The median hospital stay was 7 days. There were 3 deaths, 1 perioperative and 2 from tumor progression. Two patients had CSF leakage (9%) and 2 developed meningitis. Two children (9%) had residual neurological deficit at last follow-up evaluation. Thirteen (59%) of 22 surviving patients received adjuvant therapy. The majority of the patients remain in mainstream education and 19 of the 20 surviving children have an LESS of 3 or lower.
Conclusions:
Children tolerate complex skull base procedures well, with minimal surgical-related morbidity as well as good long-term tumor control rates and functional outcomes from maximal safe resection combined with adjuvant treatment when required.
