The Costs of Skull Base Surgery in the Pediatric Population

Object The use of endoscopic endonasal surgery (EES) for skull base pathologies in the pediatric population presents unique challenges and has not been well described. The authors reviewed their experience with endoscopic endonasal approaches in pediatric skull base surgery to assess surgical outcomes and complications in the context of presenting patient demographics and pathologies. Methods A retrospective review of 133 pediatric patients who underwent EES at our institution from July 1999 to May 2011 was performed. Results A total of 171 EESs were performed for skull base tumors in 112 patients and bony lesions in 21. Eighty-five patients (63.9%) were male, and the mean age at the time of surgery was 12.7 years (range 2.3–18.0 years). Skull base tumors included angiofibromas (n = 24), craniopharyngiomas (n = 16), Rathke cleft cysts (n = 12), pituitary adenomas (n = 11), chordomas/chondrosarcomas (n = 10), dermoid/epidermoid tumors (n = 9), and 30 other pathologies. In total, 19 tumors were malignant (17.0%). Among patients with follow-up data, gross-total resection was achieved in 16 cases of angiofibromas (76.2%), 9 of craniopharyngiomas (56.2%), 8 of Rathke cleft cysts (72.7%), 7 of pituitary adenomas (70%), 5 of chordomas/chondrosarcomas (50%), 6 of dermoid/epidermoid tumors (85.7%), and 9 cases of other pathologies (31%). Fourteen patients received adjuvant radiotherapy, and 5 received chemotherapy. Sixteen patients (15.4%) showed tumor recurrence and underwent reoperation. Bony abnormalities included skull base defects (n = 12), basilar invagination (n = 4), optic nerve compression (n = 3) and trauma (n = 2); preexisting neurological dysfunction resolved in 12 patients (57.1%), improved in 7 (33.3%), and remained unchanged in 2 (9.5%). Overall, complications included CSF leak in 14 cases (10.5%), meningitis in 5 (3.8%), transient diabetes insipidus in 8 patients (6.0%), and permanent diabetes insipidus in 12 (9.0%). Five patients (3.8%) had transient and 3 (2.3%) had permanent cranial nerve palsies. The mean follow-up time was 22.7 months (range 1–122 months); 5 patients were lost to follow-up. Conclusions Endoscopic endonasal surgery has proved to be a safe and feasible approach for the management of a variety of pediatric skull base pathologies. When appropriately indicated, EES may achieve optimal outcomes in the pediatric population.

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Endoscopic Skull Base Surgery in the Pediatric Population

Current Treatment Options in Allergy ◽

10.1007/s40521-021-00288-w ◽

2021 ◽

Author(s):

Tara Wu ◽

Zachariah Chandy ◽

Elisabeth Ference ◽

Jivianne T. Lee

Keyword(s):

Skull Base ◽

Endoscopic Sinus Surgery ◽

Skull Base Surgery ◽

Pediatric Population ◽

Similar Efficacy ◽

Sinus Surgery ◽

Surgical Approaches ◽

Invasive Approach ◽

Safety And Efficacy ◽

Primary Treatment Modality

Abstract Background Surgery is often indicated for definitive biopsy or as the primary treatment modality for pediatric skull base lesions. Traditionally, open surgical approaches were utilized to address pediatric skull base pathology. However recently, expanded endoscopic sinus surgery has been utilized as a minimally invasive approach to addressing skull base pathology in the pediatric population. Purpose This review provides an overview of the current literature evaluating the unique anatomic challenges of the pediatric skull and the safety and efficacy of expanded skull base procedures in the pediatric population. Findings The pediatric skull base and sinus anatomy is small and continues to develop throughout childhood leading to unique surgical challenges. Sphenoid sinus pneumatization and intercarotid distance at the skull base are two significant anatomic challenges to pediatric skull base surgery. Despite the distinctive anatomy challenges, recent studies demonstrate that the safety and efficacy of expanded endoscopic sinus surgery appear to be equivalent to traditional open surgical approaches. Conclusion Expanded endoscopic sinus surgery in the pediatric population has similar efficacy and safety as the traditional open approaches.

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Surgical Outcomes after Endoscopic Endonasal Skull Base Surgery in the Pediatric Population

10.1055/s-0039-1679569 ◽

2019 ◽

Author(s):

Jessica Sher ◽

Wayne Hsueh ◽

Jean Eloy ◽

James Liu

Keyword(s):

Skull Base ◽

Surgical Outcomes ◽

Skull Base Surgery ◽

Pediatric Population ◽

Endoscopic Endonasal

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Open Approaches to the Anterior Skull Base in Children: Review of the Literature

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1621739 ◽

2018 ◽

Vol 79 (01) ◽

pp. 042-046 ◽

Cited By ~ 9

Author(s):

Ari DeRowe ◽

Barak Ringel ◽

Gadi Fishman ◽

Dan Fliss ◽

Oshri Wasserzug

Keyword(s):

Skull Base ◽

Endoscopic Surgery ◽

Frontal Sinus ◽

Skull Base Surgery ◽

Pediatric Population ◽

Developed Countries ◽

Anterior Skull Base ◽

Surgical Approaches ◽

Endoscopic Skull Base Surgery ◽

Skull Base Lesions

Introduction Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the “gold standard” for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases. Objective This article reviews current concepts and open approaches to the anterior skull base in children in the era of endoscopic surgery. Materials and Methods Comprehensive literature review. Results Extensive intracranial–intradural invasion, extensive orbital invasion, encasement of the optic nerve or the internal carotid artery, lateral supraorbital dural involvement and involvement of the anterior table of the frontal sinus or lateral portion of the frontal sinus precludes endoscopic surgery, and mandates open skull base surgery. The open approaches which are used most frequently for surgical resection of anterior skull base tumors are the transfacial/transmaxillary, subcranial, and subfrontal approaches. Reconstruction of anterior skull base defects is discussed in a separate article in this supplement. Discussion Although endoscopic skull base surgery in children is gaining popularity in developed countries, in many cases open surgery is still required. In addition, in developing countries, which accounts for more than 80% of the world's population, limited access to expensive equipment precludes the use of endoscopic surgery. Several open surgical approaches are still employed to resect anterior skull base lesions in the pediatric population. With this large armamentarium of surgical approaches, tailoring the most suitable approach to a specific lesion in regard to its nature, location, and extent is of utmost importance.

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