Abstract
Introduction The fully endoscopic expanded endonasal approach (EEA) has been shown to be safe
and efficacious in pediatric patients. However, in the very young patient (ages six
and under), the anatomical challenge of working through a small nasal corridor is
problematic. The ability to repair the skull base and use a nasoseptal flap (NSF)
has also been called into question. Here, we review skull base resections using EEA
in patients aged 6 years and younger.
Methods A retrospective chart review was conducted on pediatric patients age 6 years and
younger who underwent EEA skull base resections over a 3-year period (June 2014 through
June 2017).
Results Eight children aged 6 and under with seven tumor pathologies underwent an EEA for
the resection of their skull base tumors, with a mean follow-up of 1.45 years. Only
chordoma cases required multiple-staged resections. There are no tumor recurrences
to date. A high-flow intraoperative cerebrospinal fluid (CSF) leak was encountered
in three cases, and there were no postoperative CSF leaks. CSF leaks were effectively
repaired with NSFs. One patient suffered from postoperative hypopituitarism, one patient
experienced recurrent epistaxis secondary to turbinate destruction by the tumor, and
one patient expired 8 months postresection secondary to metastatic disease.
Conclusion In our case series, EEA for skull base tumors in children aged 6 and under was a
safe and effective surgical approach. Skull base defects are able to be effectively
addressed with typical repairs including NSFs. Larger studies are warranted to further
investigate this technique in this pediatric population.
Keywords
pediatric endoscopic endonasal approach - expanded endoscopic endonasal approach -
EEA - pediatric skull base surgery - surgical complications
