Pediatric Endoscopic Skull Base Surgery: Safety, Efficacy, and Lessons Learned.

OBJECTIVE

This study aimed to describe our institution's experience with endoscopic approaches to pediatric skull base surgery.

DESIGN/SETTING/

PARTICIPANTS

A retrospective study of consecutive cases of patients under the age of 18 years who underwent endoscopic skull base surgery performed at our institution between 2016 and 2023.

MAIN OUTCOME MEASURES: Postoperative outcomes, including hospital length of stay, 30-day readmission, postop cerebrospinal fluid (CSF) leak, tumor recurrence, intracranial infection, endocrinopathy, visual deficit, or cranial neuropathy.

RESULTS

In total, 37 surgeries were performed in 32 patients: 32 primary surgeries and 5 revision surgeries. Median patient age was 13.5 years (interquartile range [IQR] 5.3 years) with a slight female predominance ( N  = 18, 56%). Surgeries were performed for skull base tumor resection ( N  = 27, 73%), skull base defect repair ( N  = 5, 14%), optic nerve decompression ( N  = 3, 8%), and skull base tumor biopsy ( N  = 2, 5%). Median length of hospital stay was 5 days (IQR 5 days); a single postoperative CSF leak required revision surgery (3%), and three patients developed postoperative intracranial infections (8%). The most common endocrinopathy developed after surgery was transient diabetes insipidus (DI) ( N  = 6, 16%). There were no cases of internal carotid artery injury, new cranial neuropathies, or vision loss after surgery. Nine of the 25 endoscopic surgeries for a skull base tumor that achieved gross total resection had tumor recurrence (36%).

CONCLUSION

Endoscopic surgery is a safe and efficacious intervention for skull base pathology in pediatric patient populations.