[Endoscopic Transnasal Surgery for Pediatric Brain Tumors].

Pediatric brain tumors differ from their adult counterparts in terms of tumor biology, anatomical constraints, and surgical challenges. Endoscopic transnasal skull base surgery (ETS) has been widely adopted in adults, and is also increasingly being applied in children as a minimally invasive approach to sellar and parasellar lesions. In pediatric cases, ETS provides a direct ventral corridor; however, it is associated with unique limitations. These include underdeveloped paranasal sinuses restricting surgical space, adherence to postoperative rest is difficult, and the skull base or midfacial growth plates, particularly the sphenooccipital synchondrosis, may be affected. Furthermore, agitation and crying may cause abrupt intracranial pressure elevation, thereby jeopardizing skull base reconstruction. Despite these challenges, advances in endoscopic equipment, navigation, and multilayer reconstruction have enabled outcomes comparable to those in adults. Pediatric ETS is applied to a wide spectrum of tumors, including craniopharyngiomas, pituitary neuroendocrine tumors, chordomas, Rathke's cleft cysts, germ cell tumors, and optic pathway gliomas. In the era of targeted therapy, minimally invasive biopsy for molecular diagnosis has gained new clinical value for ETS. Perioperative management must address pediatric-specific risks, such as limited blood volume, higher cerebrospinal fluid leak rates, and long-term craniofacial development. Ultimately, pediatric ETS requires a multidisciplinary approach involving neurosurgeons, endocrinologists, otolaryngologists, anesthesiologists, oncologists, nurses, and other allied specialists, to achieve comprehensive care.