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Published on: July 5, 2021
Pediatric Skull Base Tumors: A Management Challenge
Matheus F M Ballestero1,2, Stephanie N F de Souza2, Romilto C Pacheco Neto2
1Department of Medicine, Federal University of São Carlos, São Carlos, Brazil.
Insights
Pediatric skull base tumor surgery presents challenges, with significant rates of neurological deficits and tumor recurrence. Outcomes highlight the need for specialized care in managing these complex pediatric cranial base lesions.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Cranial base surgery
Background:
- Skull base tumors in children are diverse and pose significant challenges for pediatric neurosurgeons.
- Limited literature exists on the long-term evolution, complications, and outcomes of pediatric skull base tumor surgery.
Purpose of the Study:
- To analyze surgical outcomes, complications, and long-term results in pediatric patients undergoing skull base tumor surgery.
- To compare findings with existing literature on pediatric skull base tumors.
Main Methods:
- Retrospective analysis of 17 children who underwent surgery for cranial base lesions between 2000 and 2018.
- Comprehensive literature review of 115 children operated on for skull base tumors.
- Statistical analysis included Chi-squared, Fisher's exact, and Mann-Whitney U tests.
Main Results:
- Seventeen pediatric patients underwent skull base surgery for various tumor types.
- Gross total resection was achieved in 35.3% of cases; 70.6% had benign histology.
- Significant morbidity was observed, with 76.4% experiencing residual neurological deficits and a 17.6% recurrence rate.
Conclusions:
- Pediatric skull base tumors are challenging due to their varied pathology.
- These tumors can lead to substantial morbidity and mortality in children.
- Effective management strategies are crucial for improving outcomes in pediatric skull base tumor patients.
Context:
Skull base tumors are varied in children and are particularly challenging to pediatric neurosurgeons, with few papers in the literature describing the evolution, complications, and outcome. The authors evaluated long-term outcomes in children submitted to skull base tumor surgery and performed a literature review.
Aims:
The aim of this study was to analyze surgical results, complications, and outcomes, on comparison with previous publications.
Materials And Methods:
A retrospective analysis of children undergoing surgery at a single institution between 2000 and 2018 for lesions of the cranial base was carried out. In addition, a literature review was carried out describing a total of 115 children operated on for skull base tumors.
Statistical Analysis:
Chi-squared and Fisher's exact tests were performed to compare the distribution of categorical variables and a nonparametric Mann-Whitney U test was used to perform intergroup comparisons of continuous variables.
Results:
Seventeen children ranging in age from 8 months to 17 years (mean, 10.9 years) underwent skull base approaches. Tumor types included schwannoma, meningioma, chondroid chordoma, mature teratoma, epidermoid cyst, hemangiopericytoma, rhabdomyosarcoma, myofibroblastic inflammatory tumor, fibromyxoid sarcoma, Crooke's cell adenoma, ossifying fibroma, osteoblastoma, nasopharyngeal angiofibroma and Ewing's sarcoma. Gross total resection was achieved in 6 patients (35.3%), 12 patients (70.6%) had benign histology, and 5 patients (29.4%) had a malignant tumor. Transient postoperative cerebrospinal fluid leak affected only one patient. Thirteen children (76.4%) had a residual neurological deficit at last follow-up evaluation. Three (17.6%) surviving patients received adjuvant therapy. The rate of recurrence or lesion progression was 17.6%.
Conclusions:
Skull base tumors in children present a therapeutic challenge because of their unique pathological composition and can lead to considerable morbidity and mortality in pediatric age.
