The Pediatric Anterior Skull Base: An Otolaryngologist's Perspective

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.

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

2018 ◽  
Vol 79 (01) ◽  
pp. 042-046 ◽  
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.

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

2002 ◽  
Vol 12 (5) ◽  
pp. 1-13 ◽  
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.

scholarly journals Transnasal endoscopic approach for pediatric skull base lesions: a case series

2019 ◽  
Vol 24 (3) ◽  
pp. 246-257 ◽  
Author(s):  
Jennifer L. Quon ◽  
Lily H. Kim ◽  
Peter H. Hwang ◽  
Zara M. Patel ◽  
Gerald A. Grant ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Population ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Skull Base Tumors ◽  
Presenting Symptoms ◽  
Institutional Experience ◽  
Transnasal Endoscopic Approach ◽  
Skull Base Lesions

OBJECTIVETransnasal endoscopic transsphenoidal approaches constitute an essential technique for the resection of skull base tumors in adults. However, in the pediatric population, sellar and suprasellar lesions have historically been treated by craniotomy. Transnasal endoscopic approaches are less invasive and thus may be preferable to craniotomy, especially in children. In this case series, the authors present their institutional experience with transnasal endoscopic transsphenoidal approaches for pediatric skull base tumors.METHODSThe authors retrospectively reviewed pediatric patients (age ≤ 18 years) who had undergone transnasal endoscopic transsphenoidal approaches for either biopsy or resection of sellar or suprasellar lesions between 2007 and 2016. All operations were performed jointly by a team of pediatric neurosurgeons and skull base otolaryngologists, except for 8 cases performed by one neurosurgeon.RESULTSThe series included 42 patients between 4 and 18 years old (average 12.5 years) who underwent 51 operations. Headache (45%), visual symptoms (69%), and symptoms related to hormonal abnormalities (71%) were the predominant presenting symptoms. Improvement in preoperative symptoms was seen in 92% of cases. Most patients had craniopharyngiomas (n = 16), followed by pituitary adenomas (n = 12), Rathke cleft cysts (n = 4), germinomas (n = 4), chordomas (n = 2), and other lesion subtypes (n = 4). Lesions ranged from 0.3 to 6.2 cm (median 2.5 cm) in their greatest dimension. Gross-total resection was primarily performed (63% of cases), with 5 subsequent recurrences. Nasoseptal flaps were used in 47% of cases, fat grafts in 37%, and lumbar drains in 47%. CSF space was entered intraoperatively in 15 cases, and postoperative CSF was observed only in lesions with suprasellar extension. There were 8 cases of new hormonal deficits and 3 cases of new cranial nerve deficits. Length of hospital stay ranged from 1 to 61 days (median 5 days). Patients were clinically followed up for a median of 46 months (range 1–120 months), accompanied by a median radiological follow-up period of 45 months (range 3.8–120 months). Most patients (76%) were offered adjuvant therapy.CONCLUSIONSIn this single-institution report of the transnasal endoscopic transsphenoidal approach, the authors demonstrated that this technique is generally safe and effective for different types of pediatric skull base lesions. Favorable effects of surgery were sustained during a follow-up period of 4 years. Further refinement in technology will allow for more widespread use in the pediatric population.

Evaluation of the early endocrinological sequelae after hadron therapy on anterior skull base lesions in the adult population

2020 ◽  
Vol 45 (2) ◽  
Author(s):  
Cesare Zoia ◽  
Francesco Lombardi ◽  
Viola M. Custodi ◽  
Elisabetta Lovati ◽  
Pietro Lucotti ◽  
...  
Keyword(s):  
Skull Base ◽  
Adult Population ◽  
Anterior Skull Base ◽  
Hadron Therapy ◽  
Skull Base Lesions

Extended anterior subcranial approach for skull base tumors: long-term results

1995 ◽  
Vol 82 (6) ◽  
pp. 1002-1010 ◽  
Author(s):  
Joram Raveh ◽  
Jon B. Turk ◽  
Kurt Lädrach ◽  
Rolf Seiler ◽  
Nelson Godoy ◽  
...  
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Anterior Skull Base ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
En Bloc ◽  
Content Type ◽  
Anterior Cranial Base ◽  
Anterior Access

✓ The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical—otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival—sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

scholarly journals Endoscopic Resection of Pediatric Skull Base Tumors: An Evidence-Based Review

2018 ◽  
Vol 80 (05) ◽  
pp. 527-539 ◽  
Author(s):  
Kerolos Shenouda ◽  
Brian T. Yuhan ◽  
Ahsan Mir ◽  
Nathan Gonik ◽  
Jean Anderson Eloy ◽  
...  
Keyword(s):  
Skull Base ◽  
Endoscopic Resection ◽  
Pediatric Population ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
Nasopharyngeal Angiofibroma ◽  
Invasive Approach ◽  
Presenting Symptoms

Abstract Objectives To perform a systematic review examining experiences with endoscopic resection of skull base lesions in the pediatric population, with a focus on outcomes, recurrence, and surgical morbidities. Methods PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases were evaluated. Studies were assessed for level of evidence. Bias risk was evaluated using the Cochrane Bias tool, Grades of Recommendation, Assessment, Development and Evaluation (GRADE), and Methodological Index for Non-Randomized Studies (MINORS) criteria. Patient characteristics, pathology, site of primary disease, presenting symptoms, stage, procedure specific details, and complications were evaluated. Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines. Results Ninety-three studies met criteria for inclusion, encompassing 574 patients with skull base tumors. The GRADE and MINORS criteria determined the overall evidence to be moderate quality. The most common benign and malignant pathologies included juvenile nasopharyngeal angiofibromas (n = 239) and chondrosarcomas (n = 11) at 41.6 and 1.9%, respectively. Of all juvenile nasopharyngeal angiofibroma tumors, most presented at stage IIIa and IIIb (25.8 and 27.3%, respectively). Nasal obstruction (16.5%) and headache (16.0%) were common symptoms at initial presentation. Surgical approaches included endoscopic endonasal (n = 193, 41.2%) and endoscopic extended transsphenoidal (n = 155, 33.1%). Early (< 6 weeks) and late (>6 weeks) complications included cerebrospinal fluid leak (n = 36, 17.3%) and endocrinopathy (n = 43, 20.7%). Mean follow-up time was 37 months (0.5–180 months), with 86.5% showing no evidence of disease and 2.1% having died from disease at last follow-up. Conclusion Endoscopic skull base surgery has been shown to be a safe and effective method of treating a variety of pediatric skull base tumors. If appropriately employed, the minimally invasive approach can provide optimal results in the pediatric population.

scholarly journals Extended Frontobasal Approach for Skull Base Lesions

2021 ◽  
Author(s):  
Mohd Faheem ◽  
Raj Kumar ◽  
Hanuman Prasad Prajapati
Keyword(s):  
Skull Base ◽  
Excision Repair ◽  
Autologous Bone Graft ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
Surgical Access ◽  
Skull Base Lesions ◽  
Good Cosmesis ◽  
Large Bone ◽  
Extensive Involvement

Abstract Background Lesions involving the skull base can be approached by a variety of surgical corridors and extended frontobasal approach is one of them. It provides quite a wide exposure to lesions in the midline of anterior skull base, paranasal sinuses, and sphenoclival region. Objective To share our experience, and list the merits and demerits, of this approach for anterior skull base lesions. Methods A total of six cases were operated using extended frontobasal approach. Four of them were skull base tumors with extensive involvement of paranansal sinuses and extension into sellar, parasellar, and clival region. Fronto-orbital and sphenoethmoidal osteotomy provided adequate surgical access, thereby facilitating their excision. Two cases of frontonaso-orbital encephalocele with large bone defect at anterior skull base were also operated upon. Skull base repair was performed using autologous bone graft, pericranium, and fibrin glue. Results  Gross total excision was achieved in four cases of skull base tumors with good cosmesis as transfacial access was obviated. Excision, repair, and reconstruction of two patients with frontonaso-orbital encephalocele were also done with acceptable cosmesis. Conclusion The extended frontobasal approach is an excellent alternative for extensive anterior skull base tumors (up to posterior skull base), and also for the repair of large malformative lesions of the anterior skull base.

The Expanding Role of Endoscopic Surgery in Pediatric Skull Base Tumors

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
P. de Lacy ◽  
A. Jesurasa ◽  
A. Saxena ◽  
S. Mirza ◽  
S. Sinha
Keyword(s):  
Skull Base ◽  
Endoscopic Surgery ◽  
Skull Base Tumors
Sign in / Sign up

Export Citation Format

Share Document