Is There a Place for the Endoscope in Skull Base Surgery in Children Less Than 5 Years?

Abstract

Background The impact of transnasal endoscopic approaches to the central skull is still increasing. Its use in small children (i.e., under the age of 5 years) is of questionable value.

Patients and Methods The present study is a description of a series of five children under the age of 5 years with lesions of the central skull base.

Results Three out of five required a combined external and transnasal endoscopic approach. The transnasal access to the central skull base allowed reducing tissue damage and potentially may reduce growth deceleration.

Discussion Based on our experience on this small series we suggest that a transnasal endoscopic approach to the anterior and central skull base can be applied even in small children. To successfully operate on such delicate pathologies, a well-working interdisciplinary cooperation is mandatory.

Keywords

endoscopy - pediatric - skull base surgery

• References

• 1 Cavallo LM, Cappabianca P, Galzio R, Iaconetta G, de Divitiis E, Tschabitscher M. Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study. Neurosurgery 2005; 56 (2, Suppl): 379-389 , discussion 379–389
• 2 Frank G, Sciarretta V, Calbucci F, Farneti G, Mazzatenta D, Pasquini E. The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery 2006; 59 (1) (Suppl. 01) ONS50-ONS57 , discussion ONS50–ONS57
• 3 Cappabianca P, Kelly DF, Laws Jr ER. Endoscopic transnasal versus open transcranial cranial base surgery: the need for a serene assessment. Neurosurgery 2008; 63 (4) (Suppl. 02) 240-241 , discussion 241–243
• 4 Kassam A, Thomas AJ, Snyderman C , et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 2007; 106 (2, Suppl): 75-86
• 5 Gil Z, Patel SG, Cantu G , et al; International Collaborative Study Group. Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck 2009; 31: 308-317
• 6 Fishman G, Fliss DM, Benjamin S , et al. Multidisciplinary surgical approach for cerebrospinal fluid leak in children with complex head trauma. Childs Nerv Syst 2009; 25: 915-923
• 7 Yoon SH, Park S-H. A study of 77 cases of surgically excised scalp and skull masses in pediatric patients. Childs Nerv Syst 2008; 24: 459-465
• 8 Di Rocco F, Couloigner V, Dastoli P, Sainte-Rose C, Zerah M, Roger G. Treatment of anterior skull base defects by a transnasal endoscopic approach in children. J Neurosurg Pediatr 2010; 6: 459-463
• 9 Shah RN, Surowitz JB, Patel MR , et al. Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 2009; 119: 1067-1075
• 10 Abdel-Aziz M, El-Bosraty H, Qotb M , et al. Nasal encephalocele: endoscopic excision with anesthetic consideration. Int J Pediatr Otorhinolaryngol 2010; 74: 869-873
• 11 Marton E, Billeci D, Schiesari E, Longatti P. Transnasal endoscopic repair of cerebrospinal fluid fistulas and encephaloceles: surgical indications and complications. Minim Invasive Neurosurg 2005; 48: 175-181
• 12 Soyka MB, Holzmann D. Correlation of complications during endoscopic sinus surgery with surgeon skill level and extent of surgery. Am J Rhinol 2005; 19: 274-281
• 13 Holzmann D, Reisch R, Krayenbühl N, Hug E, Bernays RL. The transnasal transclival approach for clivus chordoma. Minim Invasive Neurosurg 2010; 53: 211-217
• 14 Locatelli D, Rampa F, Acchiardi I, Bignami M, Pistochini A, Castelnuovo P. Endoscopic endonasal approaches to anterior skull base defects in pediatric patients. Childs Nerv Syst 2006; 22: 1411-1418
• 15 Van Den Abbeele T, Elmaleh M, Herman P, François M, Narcy P. Transnasal endoscopic repair of congenital defects of the skull base in children. Arch Otolaryngol Head Neck Surg 1999; 125: 580-584
• 16 Gil Z, Patel SG, Cantu G , et al; International Collaborative Study Group. Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck 2009; 31: 308-317
• 17 Anderson S, Panizza B. Are cell salvage and autologous blood transfusion safe in endonasal surgery?. Otolaryngol Head Neck Surg 2010; 142 (3) (Suppl. 01) S3-S6
• 18 Suzuki M, Sakurai H, Seno S , et al. [Endoscopic resection of benign and malignant tumors in the nasal cavity and paranasal sinus]. Nippon Jibiinkoka Gakkai Kaiho 2005; 108: 724-733
• 19 Desmond M, Gillon J, Thomas MJG. Perioperative red cell salvage: a case for implementing the 1995 consensus statement. Transfus Med 1999; 9: 265-268
• 20 Castelnuovo P, Dallan I, Bignami M, Pistochini A, Battaglia P, Tschabitscher M. Endoscopic endonasal management of petroclival cerebrospinal fluid leaks: anatomical study and preliminary clinical experience. Minim Invasive Neurosurg 2008; 51: 336-339
• 21 Calstelnuovo P, Bignami M, Pistochini A, Battaglia P, Locatelli D, Dallan I. Endoscopic endonasal management of encephaloceles in children: An eight-year experience. Int J Pediatr Otorhinolaryngol 2009; 73: 1132-1136
• 22 Martin TJ, Loehrl TA. Endoscopic CSF leak repair. Curr Opin Otolaryngol Head Neck Surg 2007; 15: 35-39
• 23 Sciarretta V, Mazzatenta D, Ciarpaglini R, Pasquini E, Farneti G, Frank G. Surgical repair of persisting CSF leaks following standard or extended endoscopic transsphenoidal surgery for pituitary tumor. Minim Invasive Neurosurg 2010; 53: 55-59
• 24 Shah RN, Surowitz JB, Patel MR , et al. Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 2009; 119: 1067-1075
• 25 Verwoerd CD, Verwoerd-Verhoef HL. Rhinosurgery in children: basic concepts. Facial Plast Surg 2007; 23: 219-230
• 26 Pinheiro-Neto CD, Carrau RL, Prevedello DM , et al. Use of acoustic Doppler sonography to ascertain the feasibility of the pedicled nasoseptal flap after prior bilateral sphenoidotomy. Laryngoscope 2010; 120: 1798-1801
• 27 Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 2012; 122: 452-459
• 28 Solyar AY, Fried MP, Goldberg AN, Kennedy DW, Lanza DC. Pedicled nasoseptal flap is not the standard of care for skull base defects. Laryngoscope 2011; 121: 896-897 , author reply 898