Related Experiment Video
Updated: Oct 20, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Applications of Endoscopic Endonasal Surgery in Early Childhood: A Case Series
Michael M McDowell1,2, Michael Chiang1, Hussam Abou-Al-Shaar1
1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Endoscopic endonasal surgery (EES) is safe and feasible in young children, despite anatomical challenges. This study shows good outcomes for various conditions, with manageable complication rates.
Area of Science:
- Pediatric Neurosurgery
- Minimally Invasive Surgery
- Cranial Base Surgery
Background:
- Endoscopic endonasal surgery (EES) adoption in early childhood has been limited by anatomical challenges.
- This study addresses the safety and efficacy of EES in pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic endonasal surgery (EES) in children under 7 years old.
- To describe outcomes and complications associated with EES in early childhood.
Main Methods:
- Retrospective cohort study of 36 patients under 7 years old undergoing EES from 2002-2019.
- Analysis of surgical approaches, resection extent, recurrence rates, and postoperative complications.
Main Results:
- 11 gross total and 10 near-total resections achieved for 21 tumors.
- Recurrence occurred in 43% of patients, particularly with craniopharyngiomas (p=0.01).
- Post-EES cerebrospinal fluid (CSF) leak rate decreased with increased use of nasoseptal flaps and CSF diversion (8% to 4%).
- Permanent complications included 1 cranial neuropathy, 1 visual field cut, and 6 cases of panhypopituitarism (all craniopharyngiomas).
Conclusions:
- Endoscopic endonasal surgery (EES) is a safe and technically feasible option for diverse pathologies in early childhood.
- Careful patient selection and surgical technique optimization are crucial for managing complications.
Introduction:
Endoscopic endonasal surgery (EES) has been slower to gain popularity in early childhood due to anatomical challenges. We sought to describe the safety and efficacy of EES in early childhood.
Methods:
All patients younger than 7 years who underwent EES at a large Cranial Base Center from 2002 to 2019 were reviewed as a retrospective cohort study.
Results:
Thirty-six patients underwent EES before the age of 7 years. Four patients had two-stage EES. Two patients required combined transcranial and endonasal approaches. The mean age at the time of initial surgery was 4 years (range: 1-6). Twenty patients were male, and 16 were female. Of 21 tumors intended for resection, 11 patients had gross total resections, and 10 had near total (>95% tumor removed) resections. Nine patients (43%) had recurrences, of which 6 were craniopharyngiomas (p = 0.01). There was no difference in recurrence rates based on the degree of resection (p = 0.67). Three cerebrospinal fluid (CSF) leaks occurred following primary EES (8%). Following an increase in nasoseptal flap usage (31-52%) and CSF diversion (15-39%) in 2008, there was only one CSF leak out of 23 patients (4 vs. 15%; p = 0.54). Postoperatively, 1 patient developed a permanent new cranial neuropathy, and 1 patient developed a permanent visual field cut. Six patients developed permanent postoperative panhypopituitarism, of which all were craniopharyngiomas (p < 0.001). The mean follow-up was 64 months.
Conclusions:
Early childhood EES is both safe and technically feasible for a variety of pathologies.
