Endoscopic Endonasal Approach for Skull Base Lesions in the Pediatric Population

Maria Koutourousiou, MD1, Srinivas Chivukula1, Carl Snyderman, MD1, Paul Gardner, MD1, Elizabeth Tyler-Kabara, MD, PhD1

1Pittsburgh, PA United States

Keywords: endoscopic surgery, children, endoscope, skull base, brain tumor

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       Endoscopic endonasal surgery can be used for many purposes.
     The use of endoscopicendonasal approach (EEA) for skull base pathology in the pediatric population presents unique challenges and has not been well studied.
     134 pediatric patients who underwent EEA since July 1999.
     We retrospectively reviewed the medical files of 134 pediatric patients who underwent EEA since July 1999.
     In total, 172 EEAs were performed for bony abnormalities in 21 patients and skull base tumors in 113.Bony abnormalities included skull base defect (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%). Skull base tumors included angiofibromas (n=24),craniopharyngiomas (n=16), Rathke’s cleft cysts (n=12), pituitary adenomas(n=11), chordomas/chondrosarcomas (n=10), dermoid/epidermoid tumors (n=9) and 31other pathologies. In total, 19 tumors were malignant (14.5%). Fifty four lesions were solely extradural while 59 were intradural or intradurally extended. Grosstotal resection was achieved in 15 angiofibromas (65.2%), 9 craniopharyngiomas (56.3%), 8 Rathke’s cleft cysts (72.7%), 7 pituitary adenomas (70%), 5chordomas/chondrosarcomas (50%), 6 dermoids/epidermoids (75%) and 9 other pathologies (29%). Sixteen patients (12.4%) showed tumor recurrence and underwent reoperation. Fifteen patients receivedadjuvant radiotherapy, and 5 received chemotherapy. Complications included CSF leak in 19 cases (14%), meningitis in 6 (4.5%), DI in 19 (14%), new cranial nerve deficit in 3 (2.2%). The mean follow-up period was 22.7 months (range 1-122). Five patients were lost to follow-up.
     This is a retrospective study.
     EEA represents a safe and feasible surgical technique. 
     EEA has changed the traditional management of a variety of pediatric skull base diseases.


Project Roles:

M. Koutourousiou (), S. Chivukula (), C. Snyderman (), P. Gardner (), E. Tyler-Kabara ()