Pediatric Endoscopic Skull Base Approach with Preservation of Turbinate

Introduction: Endoscopic endonasal approaches to pediatric skull base lesions are rare, challenging, and present distinct considerations from adult pathology. Due to a narrower endonasal corridor and limited pneumatization, access to pediatric skull base lesions requires a distinct set of techniques. In this study, we describe our endoscopic technical approach to various skull base lesions demonstrating the efficacy and nuances of these approaches in pediatric patients.

Methods: All pediatric patients who underwent an endoscopic approach for skull base lesions from January of 2015 to April of 2021 were included in the study. Presenting symptoms, indications for surgery, surgical outcomes, intraoperative and postoperative complications, length of hospital stay, and length of follow-up were documented. Our surgical technique for these cases involves a minimally disruptive approach with preservation of the middle turbinate (unless involved by tumor) and nasal septum, with limited posterior septectomy for access to the sella and anterior skull base.

Results: A total of 18 patients (median age 12, age-range 1–15, 53% male) underwent 19 endoscopic transsphenoidal procedures. The pathology managed by the endoscopic approaches included craniopharyngioma (N = 5), biopsy for an unknown disease (n = 2; orbital meningioma and pituitary lymphocytic hypophysitis), pituitary adenoma (N = 2; ACTH and non-functional), Rathke's cleft cyst (n = 2), CSF repairs (n = 2; traumatic and spontaneous meningocele), juvenile nasopharyngeal angiofibroma (n = 3, 1 patient had 2 procedures) and rhabdomyosarcoma (n = 1). Gross total resection was achieved in 9 out of 13 patients (69%) and depended on the specific pathology. No patients experienced post-operative CSF leak or other complications. A combination of surgical repair strategies including an autologous button graft, synthetic dural substitute, dural sealant, and nasoseptal flap was used in various combinations for each case. In 14 patients with follow-up, the median follow-up was 14 months (1–36 months).

Conclusion: Anterior and middle skull base pathology in pediatric patients can be effectively operated via an endoscopic approach across a wide variety of patient ages and conditions. Minimally invasive techniques with middle turbinate and nasal septum preservation can be achieved without compromising outcomes. A wide variety of surgical repair strategies can be successfully utilized. These data suggest that surgery for complex skull base lesions in pediatric patients can be accomplished via endoscopic minimally disruptive methods.

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Artikel online veröffentlicht:
15. Februar 2022