Expanded Endonasal Endoscopic Approaches to Skull Base Lesions in Pediatric Patients

Skull base tumors are uncommon in pediatric patients and account for less than 10% of all skull base pathologies. These lesions have traditionally been approached via transcranial or transfacial corridors. Over the past decade, however, there has been a dramatic increase in endoscopic approaches in the treatment of skull base pathologies, including those in pediatric patients. Over the past 3 years, the authors have treated six patients under the age of 21 with an expanded endonasal endoscopic approach. Pathologies included a juvenile nasopharyngeal angiofibroma in two patients and an aneurysmal bone cyst, leiomyoma, CSF leak, and chordoma, each in one patient. Given the size of the lesion, a staged resection was performed in two patients. All patients tolerated the procedures well. The patient with the chordoma had third and sixth cranial nerve palsies postoperatively, which have been improving. A gross total resection was achieved in 4/5 tumor cases and a near total resection was achieved in the patient with the chordoma. There has been no recurrence noted in the four tumor cases in which a gross total resection was achieved. The patient with the chordoma is currently undergoing proton beam radiotherapy for his residual tumor remnant. There were no postoperative CSF leaks and no episodes of meningitis. Our series contributes to the growing body of literature supporting the role of expanded endonasal endoscopic procedures in selected pediatric patients with skull base pathologies.