Endoscopic Endonasal Skull Base Surgery for 38 Pediatric Cases: Ankara University Experience

Objective: To discuss the endoscopic endonasal approach in pediatric age group with its advantages and disadvantages.

Methods: Retrospective analysis of 38 pediatric patients that are operated via endonasal endoscopic approach for various indications except angiofibroma in Ankara University Medical Faculty between years 2010 to 2016 September.

Results: 24 patients (63%) were male and 14 patients were female (36%). The main age was 10.6 (2–18). Twelve of the cases were craniopharyngioma (31%), 8 pituitary adenoma (21%), 4 traumatic CSF rhinorrhea (10%), 4 meningocele (10%), 2 germinoma (5%), 2 malign tumors (5%), 2 pituitary inflammation (5%), 1 odontoidectomy (2%), 1 fibrous dysplasia (2%), 1 hemangiopericytoma (2%) and 1 capillary hemangioma (2%). Among 27 patients with pathological results; total or gross total excision was achieved in 23 (85%), subtotal resection was achieved in 2 (7%). In 2 cases of malign tumors (7%) only biopsy was made. Either traumatic or due to tumor resection, all dura lesions along the skull base was reached with endonasal endoscopic approach and watertight sealing was achieved. No patient had a postoperative CSF leak or meningitis. 9 patients had transient diabetes insipidus, 1 patient had temporary loss of lateral gaze and the case after odontoidectomy had pneumocephalus one week after surgery following a sneeze attack. One patient was died because of endocrinological failure and hypo-hypernatremia imbalance.

Conclusion: Endonasal endoscopic approach is an effective method for surgery in managing various pathologies of the pediatric age group. Due to its less invasive nature, it protects the developing bony structures of the face and the skull, while achieving satisfactory outcomes. Nevertheless narrow transnasal corridor as well as inadequate sphenoid sinus pneumatization could be the main handicaps of this approach in pediatric patients.