Surgical Outcomes after Endoscopic Endonasal Skull Base Surgery in the Pediatric Population

Introduction: The endoscopic endonasal approach (EEA) for skull base lesions has become increasingly favorable over the traditional open approach in the pediatric population. We evaluated the indications, surgical outcomes, and complications of pediatric patients who underwent endoscopic skull base surgery.

Methods: A retrospective review was performed from December 2010 to June 2018 of pediatric patients (ages: 0–18 years) who underwent EEA for skull base lesions.

Results: Twenty-one patients underwent 30 EEA surgeries in the study period. Eleven patients were female (52%), and the mean age at the time of surgery was 15.6 (range = 13.0 to 18.5 years). Selected pathologies included pituitary adenoma (n = 6), craniopharyngioma (n = 3), osteoblastoma (n = 2), juvenile nasopharyngeal angiofibroma (n = 3), chordoma (n = 2), Rathke cleft cyst (n = 1), meningioma (n = 1), nasopharyngeal carcinoma (n = 1), odontoid pannus (n = 1), and anterior skull base mass (n = 1). Gross-total resection was achieved in 11 applicable cases (69%), near-total resection in 3 cases (19%), and subtotal resection in 2 cases (12%). Six patients presented with additional endocrine pathologies (29%). One patient presented with Cushing’s disease, and 5 patients presented with hyperprolactinemia; all 6 patients showed resolution of endocrine symptoms (100%). There were four patients who had tumor recurrence (19%) and two patients of postoperative CSF leak (10%). The mean follow-up time was 38.0 months (range: 2–90 months).

Conclusion: EEA is a safe and acceptable approach for a variety of appropriately selected skull base lesions in the pediatric population. High rates of gross-total resection and low rates of complications can be achieved in the pediatric population with an experienced multidisciplinary endoscopic skull base team.