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Updated: Jan 25, 2026

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Endonasal endoscopic skullbase surgery in children.

Chandrashekhar E Deopujari1, Nishit J Shah2, Salman T Shaikh3

  • 1Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India. d.chandrashekhar11@gmail.com.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|May 13, 2019
PubMed
Summary

The endonasal endoscopic approach is a viable surgical option for pediatric skull base pathologies, offering successful outcomes despite anatomical challenges. This technique enables effective tumor excision and defect reconstruction in children.

Keywords:
EndonasalEndoscopyPaediatricSkullbase

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Area of Science:

  • Neurosurgery
  • Pediatric Surgery
  • Endoscopic Surgery

Background:

  • The endonasal endoscopic approach (EEA) for pediatric skull base pathologies is evolving but not yet standard neurosurgical care.
  • Challenges include narrow access, instrument manipulation, and reconstruction in children.
  • This study details experience from a single neurosurgical unit over 12 years.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of the endonasal endoscopic approach in pediatric skull base surgery.
  • To assess the efficacy of EEA for various pathologies in children.
  • To report on reconstruction techniques, including vascularized flaps.

Main Methods:

  • A case series of 59 pediatric skull base surgeries in 49 children (4 months to 18 years) using the EEA.
  • Pathologies included craniopharyngiomas, pituitary adenomas, CSF rhinorrhea, and others.
  • Cerebrospinal fluid (CSF) leak repair evolved from free grafts to vascularized flaps.

Main Results:

  • Surgical goals were achieved in most cases; tumor excision extent was not compromised by EEA.
  • Two cases had unsatisfactory tumor excision due to cyst wall non-collapse.
  • Three patients required revision surgery for CSF leaks; nasoseptal flaps were successful even in young patients.

Conclusions:

  • Endoscopic endonasal corridor surgery is feasible and successful in selected pediatric skull base cases.
  • Challenges of pediatric anatomy can be overcome with this approach.
  • Vascularized nasoseptal flaps are a reliable reconstruction method in pediatric patients.