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Craniofacial access in children
D A Lang1, G Neil-Dwyer, B T Evans
1Department of Neurosurgery, Southampton General Hospital, U.K.
Insights
Craniofacial access techniques were successfully applied to pediatric patients with complex skull base and intracranial conditions. This approach led to good functional and cosmetic outcomes with minimal complications, supporting normal craniofacial growth.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Skull Base Surgery
Background:
- Complex skull base and intracranial pathologies present unique surgical challenges in children.
- Established adult craniofacial access techniques have been adapted for pediatric neurosurgery.
- Individualized surgical planning is crucial for optimal outcomes in pediatric neurosurgery.
Purpose of the Study:
- To evaluate the application and outcomes of craniofacial access techniques in pediatric patients with complex skull base and intracranial pathologies.
- To assess the safety and efficacy of these extended surgical approaches in a pediatric population.
- To highlight the importance of tailored surgical strategies for individual patient needs.
Main Methods:
- Retrospective review of 20 pediatric patients (age 3-14 years) undergoing craniofacial access for complex skull base/intracranial pathology.
- Utilized various craniofacial access techniques including transzygomatic, orbital, transoral, transmandibular, petrous, transcondylar, translabyrinthine, and transbasal approaches.
- Surgical indications included tumors (skull base, suprasellar, acoustic neuroma), aneurysms, arteriovenous malformations (AVMs), and congenital anomalies.
Main Results:
- Successful application of craniofacial access techniques in pediatric patients.
- Achieved good functional and cosmetic results with minimal complications.
- No observed complications related to craniofacial growth.
- Majority of patients returned to normal school activities.
Conclusions:
- Established adult craniofacial access techniques can be safely and effectively extended to pediatric practice for complex skull base and intracranial pathologies.
- Individualized surgical approach construction is paramount for successful outcomes.
- Multidisciplinary team expertise, including pediatric and neurosurgical specialists, is essential for managing these challenging cases.
- The findings support the need for specialist referral in pediatric neurosurgery for complex vascular and skull base conditions.
Abstract:
We have used craniofacial access in 20 children (age range 3/12-14 years) for complex skull base/intracranial pathology over the past 5 years. The majority of the patients had a tumour-7 of the skull base, 5 extensive suprasellar lesions and 3 acoustic neuromas; 4 had an aneurysm or AVM and in 1 there was a congenital problem. This extended application of established adult techniques in a paediatric practice emphasises the fundamental point that the quintessence of good surgical practice is the construction of an operation for the individual patient's pathology. We therefore used transzygomatic, orbital, transoral, transmandibular, petrous, transcondylar, translabyrinthine and transbasal access techniques. Good function and cosmesis with minimal complications were achieved. We have not observed complications with craniofacial growth and the majority of patients were able to return to normal school. The range of approaches used emphasise the importance of a multidisciplinary team with both paediatric and neurosurgical expertise, especially with complex vascular and skull base pathology, in dealing with these difficult problems. The case for specialist referral merits some discussion within the representative bodies of paediatric neurosurgeons.