Early Initiation of Adjuvant Therapy Following Pediatric Endoscopic Endonasal Surgery for Tumors.

OBJECTIVE

To evaluate complication rates of early adjuvant therapy initiation in pediatric patients with endoscopic endonasal resection for skull base tumors.

DESIGN

Retrospective case series of pediatric patients (0-18 years old) with skull base tumors who underwent endoscopic endonasal resection between 2013 and 2023. The median follow-up was 4.21 years.

SETTING

Single, urban academic pediatric center.

PARTICIPANTS

Patients who received radiation within 3 months and/or chemotherapy within 2 weeks of endoscopic endonasal resection.

MAIN OUTCOME MEASURES: Primary outcomes were perioperative and adjuvant therapy-related complications including reconstruction failure. Secondary outcomes were recurrence and overall survival.

RESULTS

This study included 16 patients (radiation [n = 10]; chemoradiation [n = 2]; chemotherapy [n = 4]) with a variety of tumor types and high dural reconstruction rate (93.8%, n = 15). The average time to radiation was 39 days. The average time to chemotherapy was 9.5 days. The most common reconstructive method included nasoseptal flap and nasoseptal flap plus fat/tensor fascia lata. No patients in either group experienced cerebrospinal fluid (CSF) leaks postoperatively or during adjuvant therapy. Only one patient experienced a recurrence post-resection, and overall survival at the median follow-up time was 91%.

CONCLUSIONS

A majority of our patient cohort experienced intraoperative CSF leaks resulting in a high rate of complex endonasal reconstructions. Adjuvant treatment postoperatively did not incur significant complications, despite initiation of radiation as early as postoperative day 1 or chemotherapy as early as postoperative day 0, demonstrating preliminary support of the safety of early adjuvant therapy initiation following endoscopic endonasal procedures in the pediatric skull base tumor population.