Endoscopic Endonasal Approach to Anterior Skull Base Tumor Resection in Young Children

Background: Historically, young children with anterior skull base tumors have been approached surgically via open craniotomy. Recently, an endoscopic endonasal approach (EEA) has been utilized more frequently within the pediatric population. However, there is widespread doubt within the literature as to whether an EEA is safe and feasible in young children, both for access for tumor resection and skull base reconstruction, due to constraints with anatomy and instrumentation.

Methods: A retrospective review of all patients aged 5 or younger undergoing an EEA for anterior skull base tumor resection at our institution between September 2017 and July 2023 was performed. Only patients planned for definitive surgical treatment with gross total tumor resection were included. Patients undergoing an EEA for biopsy alone were excluded. Patient demographics and clinical characteristics were collected from the electronic medical record.

Results: Ten patients met study criteria and were included in analysis. Average patient age was 3.53 years (range: 0.97–5.45 years). Three patients were under the age of 2 at the time of surgery. Pathologies consisted of 7 craniopharyngioma, 1 suprasellar dermoid cyst, 1 suprasellar retinoblastoma, and 1 clival chordoma. All sellar or suprasellar tumor cases underwent endoscopic reconstruction with tensor fascia lata and fat as well as a nasoseptal flap. The chordoma patient was reconstructed with a nasoseptal flap without fat or fascia. There were no postoperative CSF leaks among the tumor resection patients.

Conclusion: An EEA was safe and effective for anterior skull base tumor resection among young children in our case series. Complex anterior skull base reconstruction was feasible at all ages with a pedicled nasoseptal flap with or without fat and fascia grafts. Future work building on this preliminary analysis will be helpful to further evaluate the EEA within this population.

Publication History

Article published online:
05 February 2024