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

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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The Pediatric Anterior Skull Base: An Otolaryngologist's Perspective

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1280 ◽

2016 ◽

Vol 7 (2) ◽

pp. 143-148

Author(s):

Ron B Mitchell ◽

Andrew J Chang ◽

Gopi B Shah

Keyword(s):

Skull Base ◽

Endoscopic Surgery ◽

Pediatric Population ◽

Adult Population ◽

Anterior Skull Base ◽

Surgical Approaches ◽

Skull Base Tumors ◽

Skull Base Lesions ◽

Head Neck

ABSTRACT Anterior skull base tumors have traditionally posed a therapeutic challenge. However, the advancement of skull base and endoscopic surgery has allowed for more of these lesions to be amenable to surgical resection. Though common in the adult population, surgical approaches in the pediatric population is not widely described. This chapter discusses the presentation and treatment for various pediatric anterior skull base lesions. Surgical approaches, complications, and the role of the otolaryngologist is also discussed. How to cite this article Chang AJ, Mitchell RB, Shah GB. The Pediatric Anterior Skull Base: An Otolaryngologist's Perspective. Int J Head Neck Surg 2016;7(2):143-148.

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Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery

Operative Neurosurgery ◽

10.1093/ons/opz355 ◽

2019 ◽

Vol 19 (1) ◽

pp. 43-52 ◽

Cited By ~ 2

Author(s):

Joshua Zeiger ◽

Anthony Costa ◽

Joshua Bederson ◽

Raj K Shrivastava ◽

Alfred M C Iloreta

Keyword(s):

Skull Base ◽

Endoscopic Surgery ◽

Mixed Reality ◽

Skull Base Surgery ◽

Anterior Skull Base ◽

Endoscopic Endonasal ◽

3 Dimensional ◽

Camera View ◽

Clinical Series ◽

Cerebrospinal Fluid Leaks

Abstract BACKGROUND Neuronavigation systems assist with spatial orientation during endoscopic transnasal skull base surgery, but they require a correlation of 3-dimensional (3D) views with 2-dimensional (2D) radiology studies. OBJECTIVE To outline an initial experience with a novel technology platform that provides intraoperative navigation using 3D reconstructions of patient anatomy for endoscopic surgery. METHODS A retrospective study of endoscopic anterior skull base and complex paranasal procedures was performed. Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create 3D digital models of patient anatomy. Using the technology developed by Surgical Theater (Mayfield Village, Ohio), these reconstructions were designed to highlight particular anatomic regions of interest. The models were studied to guide the surgical approach and anticipate critical structures. The reconstructions were linked with the navigational technology created by Brainlab (Munich, Germany) during endoscopic surgery. A dynamic image of the reconstruction was displayed alongside a matching endoscopic camera view. These 2 views could be overlaid to provide an immersive, mixed reality image of the patient's anatomy. RESULTS A total of 134 cases were performed. The pathologies included tumors of the anterior skull base or sinonasal cavity, inflammatory sinus disease, and cerebrospinal fluid leaks. Specific anatomic structures, such as the internal carotid arteries and optic nerves, were chosen for enhancement. Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures. CONCLUSION We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.

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Long Term Sinusitis Outcomes of Endoscopic Skull Base Surgery: Comparison of Minimally Invasive Pituitary Surgery versus Expanded Endoscopic Surgery for Malignancy

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1579824 ◽

2016 ◽

Vol 77 (S 01) ◽

Author(s):

Lauren Fedore ◽

Adam Zanation

Keyword(s):

Minimally Invasive ◽

Skull Base ◽

Endoscopic Surgery ◽

Skull Base Surgery ◽

Pituitary Surgery ◽

Endoscopic Skull Base Surgery

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A Novel Technique for Endoscopic Repair of Large Anterior Skull Base Defects: The PDS Wrap

American Journal of Rhinology and Allergy ◽

10.1177/1945892419873991 ◽

2019 ◽

Vol 34 (1) ◽

pp. 70-73 ◽

Cited By ~ 1

Author(s):

Karan Jolly ◽

Okechukwu Okonkwo ◽

Georgios Tsermoulas ◽

Shahzada K. Ahmed

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Skull Base Surgery ◽

Cerebrospinal Fluid Leak ◽

Anterior Skull Base ◽

Brain Herniation ◽

Novel Technique ◽

Endoscopic Skull Base Surgery ◽

Fluid Leak ◽

The Brain

Background Endoscopic skull base surgery continues to push boundaries with increased complexity of work and subsequently larger defects requiring repair. Robust repair following endoscopic skull base surgery is essential to reduce significant postoperative complications such as cerebrospinal fluid leak, meningitis, and pneumocephalus. Objective To describe and further validate our novel technique of using a polydioxanone plate wrap used in large anterior skull base resections where brain herniation can be of concern. Method After large resections where there is obvious brain herniation, our PDS (polydioxanone) wrap can be deployed to provide rigid support to the brain. The PDS plate is wrapped in a dural graft material and sutured closed in order to allow deployment by releasing the sutures when in position under the bony ridge of the defect. Conclusion Till date we have successfully used this technique in 3 patients following large skull base resections of olfactory meningiomas, where there was herniation of the brain. Postoperatively, there was no evidence of cerebrospinal fluid leak. We therefore recommend the use of the PDS wrap to prevent brain herniation and provide additional support to the repair.

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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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Endoscopic transsphenoidal resection of craniopharyngioma

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v50i2.338 ◽

2021 ◽

Vol 50 (2) ◽

pp. 152

Author(s):

Esmaralda Nurul Amany

Keyword(s):

Skull Base ◽

Endoscopic Surgery ◽

Skull Base Surgery ◽

Tumor Resection ◽

Endoscopic Approach ◽

Cochrane Library ◽

Morbidity Rate ◽

Literature Study ◽

Endoscopic Skull Base Surgery ◽

Microscopic Surgery

ABSTRACTBackground: Endoscopic surgery techniques had been advancing in this last two decades. Transsphenoidal approach endoscopic surgery to the skull base provides better visualization of the operation field compared to microscopic surgery, and also brought lower morbidity than other techniques. Purpose: To report a transsphenoidal endoscopic skull base surgery for craniopharyngioma resection. Case Report: A case of craniopharyngioma in a 47-year-old man. The tumor resection was performed with transsphenoidal endoscopic approach, in collaboration with a neurosurgeon. Clinical Question: Is transsphenoidal endoscopic skull base surgery approach, the appropriate surgical procedure for craniopharyngioma management? Review Method: Evidence based literature study of skull base surgery with transsphenoidal endoscopic approach in craniopharyngioma through database Cochrane library, Pubmed Medline, and hand searching. Result: Skull base surgery with transsphenoidal endoscopic approach was minimally invasive with maximally invasion compared to transcranial surgery, and also provided better view, and could reduce complication rate. Conclusion: Skull base surgery with transsphenoidal endoscopic approach offers more advantage in skull base lesion management compared to other techniques. Collaboration between neurosurgeon and otorhinolaryngologist using this technique could reduce complication and morbidity rate. ABSTRAKLatar belakang: Teknik operasi endoskopi mengalami perkembangan pesat dalam dua dekade terakhir. Bedah basis kranii dengan pendekatan endoskopi transfenoid memberikan kualitas visualisasi lapang pandang operasi lebih baik dibanding menggunakan mikroskop, dan juga mengakibatkan morbiditas lebih rendah dibanding teknik lainnya. Tujuan: Melaporkan keberhasilan bedah basis kranii dengan pendekatan endoskopi transfenoid pada kraniofaringioma. Laporan kasus: Seorang laki-laki 47 tahun dengan diagnosis kraniofaringioma yang dilakukan tindakan reseksi tumor dengan pendekatan endoskopi transfenoid berkolaborasi dengan ahli bedah saraf. Pertanyaan Klinis: Apakah bedah basis kranii dengan pendekatan endoskopi transfenoid merupakan teknik operasi yang tepat untuk tatalaksana kraniofaringioma? Telaah literatur: Telaah literatur berbasis bukti mengenai bedah basis kranii dengan pendekatan endoskopi transfenoid pada kraniofaringioma melalui database Cochrane library, Pubmed Medline, dan pencarian manual. Hasil: Bedah basis kranii dengan pendekatan endoskopi transfenoid memberikan akses minimal dengan invasi maksimal, visualisasi lebih baik, dan dapat menurunkan angka komplikasi. Kesimpulan: Bedah basis kranii dengan pendekatan endoskopi transfenoid merupakan teknik operasi lesi basis kranii yang lebih unggul dibandingkan teknik lainnya. Kolaborasi antara ahli bedah saraf dan THT dapat mengurangi angka komplikasi dan morbiditas tindakan ini.

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Tumors of the skull base in children: review of tumor types and management strategies

Neurosurgical FOCUS ◽

10.3171/foc.2002.12.5.2 ◽

2002 ◽

Vol 12 (5) ◽

pp. 1-13 ◽

Cited By ~ 44

Author(s):

Eve C. Tsai ◽

Stephen Santoreneos ◽

James T. Rutka

Keyword(s):

Skull Base ◽

Pediatric Population ◽

Management Strategies ◽

Treatment Strategies ◽

Surgical Approaches ◽

Skull Base Tumors ◽

Nasopharyngeal Angiofibroma ◽

Review Management ◽

Skull Base Lesions ◽

Skull Base Anatomy

Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.

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Gigant Transethmoidal Meningoencephalocele Operated by Full Endonasal Endoscopic Approach: Case Report

Case Reports in Medicine ◽

10.1155/2012/763259 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Omar Lopez Arbolay ◽

Jorge Rojas Manresa ◽

Justo Gonzalez Gonzalez ◽

Jose Luis Bretón Rosario

Keyword(s):

Case Report ◽

Skull Base ◽

Skull Base Surgery ◽

Clinical Manifestations ◽

Anterior Skull Base ◽

Endoscopic Approach ◽

Surgical Morbidity ◽

Endoscopic Skull Base Surgery ◽

Watertight Closure ◽

Skull Base Defect

Intranasal meningoencephaloceles have historically been managed by neurosurgeons, although their main clinical manifestations are rhinological. Recent advances in endoscopic skull base surgery has significantly improved the treatment of these lesions and consequently diminished appreciable surgical morbidity. We report an ethmoidal meningoencephalocele case operated on by endonasal endoscopic approach for removal of the lesion and reconstructing the associated skull base. From this experience, we conclude that removal of the lesion and watertight closure of the skull base irrespective of the size of the mass and anterior skull base defect are the operation’s most important aspects.

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