Ahead of Print: Corridor-based EEA in Pediatric Patients

Screen Shot 2013-12-03 at 9.06.02 AMBackground: Pediatric anatomy is more restricted and the propagation of endonasal endoscopic approaches (EEA) in the pediatric population has been limited.

Objective: To demonstrate feasibility of EEA in a variety of age groups and to perform measurements of the corridors and spaces available for surgery as a guide for case selection.

Methods: Only patients <18 years were included. Choice of operative corridor/approach is described in relation to pathological entity and location. Pre-operative/post-operative visual fields and endocrine panels, extent of resection, as well as post-operative long-term complications are described. Prospective MRI-based anatomical measurements of key distances were performed to determine age-dependent surgical indications and limitations.

Results: 40 purely endoscopic procedures were performed in 33 pediatric patients (5-18 years) harboring a variety of skull base lesions, from benign tumors to congenital malformations. For the 20 patients in whom gross total resection (GTR) was the intended goal of surgery, GTR was attained in 15 (75%). There were 2 infections (5%) and no CSF leaks. 58.3% of patients with visual deficits showed significant improvement. Hormone overproduction resolved in 75% of patients, while pre-operative hormone insufficiency only improved in 29.2%. Wider inter-carotid distance at the superior clivus (ICD-SC, p=0.01) and shorter nare-dens working distance (NDD, p=0.001) predicted improved outcomes and fewer post-operative complications.

Conclusion: Endonasal endoscopic skull base approaches are viable in the pediatric population, not impeded by sphenoid sinus aeration, and have minimal risk of CSF leak and meningitis. Outcomes and complications can be predicted based on specific radioanatomical skull base measurements rather than age.

From: Corridor-Based Endonasal Endoscopic Surgery for Pediatric Skull Base Pathology with Detailed Radioanatomical Measurements by Banu et al.

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.