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Published on: July 5, 2021
Pediatric Endoscopic Skull Base Surgery: Safety, Efficacy, and Lessons Learned
Daniel P Lander1, Peter Yang2, Kate Dunsky1
1Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States.
Insights
Endoscopic skull base surgery is safe and effective for pediatric patients. This approach demonstrated low complication rates and positive outcomes for various skull base conditions in children.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Otolaryngology
Background:
- Skull base surgery in children presents unique challenges.
- Minimally invasive techniques are increasingly explored for pediatric neurosurgical procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic approaches for pediatric skull base surgery.
- To report institutional experience with endoscopic skull base procedures in patients under 18 years of age.
Main Methods:
- Retrospective review of pediatric patients (<18 years) undergoing endoscopic skull base surgery from 2016-2023.
- Analysis of surgical indications including tumors, defects, and decompression.
- Assessment of postoperative outcomes: length of stay, complications (CSF leak, infection), and long-term sequelae.
Main Results:
- 37 surgeries were performed in 32 pediatric patients.
- Common indications included tumor resection (73%) and defect repair (14%).
- Low complication rates observed: 3% CSF leak, 8% intracranial infection; no vascular or new neurological deficits. Tumor recurrence was 36% in resected tumors.
Conclusions:
- Endoscopic skull base surgery is a safe and effective treatment modality for pediatric patients.
- The technique offers favorable outcomes with manageable complication rates.
- Further research can explore long-term oncological control and functional outcomes.
Objective:
This study aimed to describe our institution's experience with endoscopic approaches to pediatric skull base surgery.
Design/Setting/Participants:
A retrospective study of consecutive cases of patients under the age of 18 years who underwent endoscopic skull base surgery performed at our institution between 2016 and 2023.
Main Outcome Measures:
Postoperative outcomes, including hospital length of stay, 30-day readmission, postop cerebrospinal fluid (CSF) leak, tumor recurrence, intracranial infection, endocrinopathy, visual deficit, or cranial neuropathy.
Results:
In total, 37 surgeries were performed in 32 patients: 32 primary surgeries and 5 revision surgeries. Median patient age was 13.5 years (interquartile range [IQR] 5.3 years) with a slight female predominance ( N = 18, 56%). Surgeries were performed for skull base tumor resection ( N = 27, 73%), skull base defect repair ( N = 5, 14%), optic nerve decompression ( N = 3, 8%), and skull base tumor biopsy ( N = 2, 5%). Median length of hospital stay was 5 days (IQR 5 days); a single postoperative CSF leak required revision surgery (3%), and three patients developed postoperative intracranial infections (8%). The most common endocrinopathy developed after surgery was transient diabetes insipidus (DI) ( N = 6, 16%). There were no cases of internal carotid artery injury, new cranial neuropathies, or vision loss after surgery. Nine of the 25 endoscopic surgeries for a skull base tumor that achieved gross total resection had tumor recurrence (36%).
Conclusion:
Endoscopic surgery is a safe and efficacious intervention for skull base pathology in pediatric patient populations.
