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

Abstract

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.

Keywords

pediatric - skull base surgery - endoscopic surgery - outcomes

Publication History

Received: 08 December 2024

Accepted: 28 June 2025

Accepted Manuscript online:
01 July 2025

Article published online:
16 July 2025

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