Minimally invasive endoscopic approaches to pediatric skull base pathologies

Area of Science:

• Neurosurgery
• Otolaryngology
• Pediatric Surgery

Background:

• Pediatric skull base lesions require specialized surgical considerations.
• Endoscopic endonasal approaches (EEA) are less common in pediatric patients compared to adults.
• EEA offers potential advantages in minimally invasive treatment for pediatric skull base pathology.

Purpose of the Study:

• To describe the technical aspects of EEA for pediatric skull base lesions.
• To evaluate the efficacy and safety of EEA in a pediatric cohort.
• To highlight the distinct considerations for EEA in pediatric skull base surgery.

Main Methods:

• Retrospective review of pediatric patients undergoing EEA for skull base lesions (January 2015-April 2021).
• Data collection included presenting symptoms, surgical indications, outcomes, complications, and follow-up.
• Analysis focused on the technical approach and patient outcomes.

Main Results:

• 18 pediatric patients underwent 19 EEAs for diverse pathologies including craniopharyngioma, angiofibroma, and CSF leaks.
• Gross total resection (GTR) was achieved in 73.3% of applicable procedures.
• Intraoperative CSF leak occurred in 60% of sellar lesion cases, with no postoperative leaks reported.

Conclusions:

• EEA is a safe and effective surgical modality for anterior and middle skull base pathologies in pediatric patients.
• Minimally invasive techniques, including preservation of nasal structures, can be employed without compromising surgical outcomes.
• Various surgical repair strategies are feasible and successful within the EEA framework for pediatric skull base lesions.