Review of skull base surgery approaches: With special reference to pediatric patients

Objectives: The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study’s aim is to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents ages 0-18 years. Design: A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000-2020 using PRISMA guidelines. Final inclusion criteria included: case series with 10+ patients with pediatric patients age ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting: Tertiary care medical center Participants: Children/adolescents ages 0-18 years who underwent endoscopic skull base surgery Main Outcome Measures: Patient demographics, pathology, reconstructive technique, intra-operative findings, intra-operative and post-operative surgical complications. Results: Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients age 0-18 years met inclusion criteria for final analysis. 7 of 12 studies discussed a single pathology. The most common pathology was a skull base defect causing CSF leak. The majority of skull base repairs were made with free tissue grafts. The most common post-operative complication was CSF leak (n=40). Twelve cases of meningitis occurred post-operatively with two of these episodes resulting in death. Conclusions: Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

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The impact of expanded endonasal skull base surgery on midfacial growth in pediatric patients

The Laryngoscope ◽

10.1002/lary.28063 ◽

2019 ◽

Vol 130 (2) ◽

pp. 338-342 ◽

Cited By ~ 5

Author(s):

Arjun K. Parasher ◽

David K. Lerner ◽

Jordan T. Glicksman ◽

Phillip B. Storm ◽

John Y.K. Lee ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

The Impact

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Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2016.12.019 ◽

2017 ◽

Vol 93 ◽

pp. 163-166 ◽

Cited By ~ 20

Author(s):

Amanda L. Stapleton ◽

Elizabeth C. Tyler-Kabara ◽

Paul A. Gardner ◽

Carl H. Snyderman ◽

Eric W. Wang

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Leak ◽

Endoscopic Endonasal ◽

Fluid Leak

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138 Endoscopic Endonasal Skull Base Surgery in Pediatric Patients and Impact on Midface Growth

Neurosurgery ◽

10.1093/neuros/nyx417.138 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 232-232

Author(s):

Wendy Chen ◽

Shih-Dun Liu ◽

Barton F Branstetter ◽

Yue-Fang Chang ◽

Lindsay A Schuster ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

Score Test ◽

Growth Period ◽

Cranial Base ◽

Tumor Type ◽

Endoscopic Endonasal ◽

Significant Difference ◽

Maxilla And Mandible

Abstract INTRODUCTION Cranial base development plays a large role in anterior and vertical maxillary growth through age 7, and the effect of early endonasal cranial base surgery on midface growth is unknown. We present our experience with pediatric endoscopic endonasal surgery and long-term midface growth. METHODS This is a retrospective review (2000-2016). Pediatric patients were grouped by age at first endoscopic endonasal skull base surgery (<7 yo and >7 yo). Included patients had both pre- and post-operative (>1 yr) imaging. Radiologists performed measurements (Sella-Nasion distance and angles from S-N to maxilla and mandible (SNA, SNB, ANB)), which were compared to age- and sex-matched Bolton standards. Z score test was used; significance was set at P < 0.05. RESULTS >The <7 yo group had 11 patients, averaging follow-up of 5 yrs; the >7 yo group had 33 patients. Most tumors were benign; one patient with a panclival AVM was a significant outlier for all measurements. Comparing the <7 yo group to Bolton standard norms, there was no significant difference in post-operative SNA (P = 0.10), SNB (P = 0.14), or ANB (0.67). SN distance was reduced both pre- and post-operatively (SD = 1.5, P = 0.01 and P = 0.009). Sex had no significant effect. Compared to patients who had surgery in the >7 yo group, the <7 yo group demonstrated no significant difference in pre- to post-operative changes with regard to S-N (P = 0.87), SNA (P = 0.89), and ANB (P = 0.14). Tumor type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group. CONCLUSION Though our cohort of patients with skull base tumors demonstrate some abnormal measurements before their operation, their post-operative cephalometrics fall within normal standard deviations and generally have no significant difference compared to patients who underwent operations at an older age. Therefore, there appears to be no evidence of impact of endoscopic endonasal skull base surgery on craniofacial development within the growth period studied.

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Endoscopic Endonasal Skull Base Surgery in Pediatric Patients. Review of the First Experience

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1600830 ◽

2017 ◽

Vol 78 (S 01) ◽

pp. S1-S156

Author(s):

Bakhtiyar Pashaev ◽

Valery Danilov ◽

Vladimir Ivanov ◽

Elza Fatikhova ◽

Jamil Rzaev ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

Endoscopic Endonasal

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Endoscopic Transnasal Skull Base Surgery in Pediatric Patients

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1692641 ◽

2019 ◽

Vol 81 (05) ◽

pp. 515-525

Author(s):

Gokmen Kahilogullari ◽

Cem Meco ◽

Suha Beton ◽

Murat Zaimoglu ◽

Onur Ozgural ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patients ◽

Skull Base Surgery ◽

Total Resection ◽

Visual Deficits ◽

Tertiary Center ◽

Before And After ◽

Effective Option ◽

Transnasal Surgery ◽

Visual Testing

Introduction In pediatric patients, endoscopic transnasal surgery (ETNS) poses challenges because of the small size of the developing skull and narrow endonasal corridors. Objective This study aimed to evaluate the efficacy of ETNS in children by assessing our experience of endoscopic skull base surgery. Materials and Methods All pediatric patients (n = 54) who were eligible for surgery using only the endonasal endoscopic approach at our tertiary center between 2012 and 2018 were included in this study. The surgeries were performed simultaneously by an endoscopic skull base team of neurosurgeons and otolaryngologists. Hormonal analyses were conducted before and after surgery in all patients with sellar/parasellar lesions. Patients older than 8 years underwent smell and visual testing. Results In the 54 patients aged 1 to 17 years who underwent surgery, craniopharyngioma was the most common pathology (29.6%), followed by pituitary adenoma (22.2%). Gross total resection was achieved in 33 (76.7%) of 41 patients who underwent surgery because of the presence of tumors. All visual deficits improved, although one patient sustained olfactory deterioration. Sixteen (29.6%) patients presented with complications such as transient diabetes insipidus and temporary visual loss. Conclusions Despite anatomy-related challenges in children, adequate results can be achieved with high rates of success, and the functional and anatomical integrity of the developing skull and nose of children can be preserved. In pediatric patients, ETNS is a safe and effective option for addressing various lesions along the skull base.

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