2025 Proffered Presentations
S279: EXPERIENCE IN ENDOSCOPIC SKULL BASE SURGERY OF PEDIATRIC PATIENTS TREATED IN A TERTIARY CARE NEUROSURGICAL CENTER
Mariela Villalobos, MD; Francisco Ringler, MD; Homero Sariego, MD; Katherine Walker, MD; Matias Gomez; Dr. Asenjo Institute of Neurosurgery
INTRODUCTION: The pathology of the cranial base in pediatric patients requires a multidisciplinary approach and varies significantly based on anatomical features and surgical objectives. It is crucial to understand the nuances of reconstruction to achieve successful outcomes. In this study, we present a series of cases involving endoscopic skull base surgery over the past 12 years at a tertiary neurosurgery hospital.
OBJECTIVES/METHODS:
General Objective: To describe the safety and efficacy of endoscopic nasal management for skull base surgery in pediatric patients through a retrospective descriptive analysis.
Specific Objectives:
- To describe the epidemiological and clinical characteristics of the included patients.
- To characterize the surgical techniques used in the management of sinonasal and tumoral pathologies.
- To outline the complications associated with endoscopic procedures.
Inclusion Criteria:
- Patients under 15 years of age.
- Surgery performed via an endoscopic nasal approach by an otorhinolaryngology team, with or without collaboration from neurosurgery, between December 2012 and June 2024 at our institution.
Exclusion Criteria:
- Incomplete data recorded in physical/electronic records for data analysis.
RESULTS: The series included 50 patients who underwent 66 endoscopic surgeries: 41 primary surgeries and 25 reoperations, with endoscopic approaches predominantly performed by both otorhinolaryngologists and neurosurgeons in both groups. The average age of operated patients was 10 years (age range 2–14 years), with 46.97% being female.
Presenting signs and symptoms included vision abnormalities (59.09%), endocrinopathies (43.94%), headaches (39.39%), and cranial nerve deficits (24.24%).
The endoscopic endonasal approach (EEA) was utilized in 85.37% of primary surgeries and 96.00% of reoperations, with 13.64% requiring neuronavigation assistance. The rescue flap technique was employed in 40.91% of procedures.
Diseases treated included craniopharyngioma (24.24%), nasal fibroangioma (13.64%), pituitary adenoma (9.09%), basilar impression (6.06%), encephalocele (4.55%), cerebrospinal fluid fistula (4.55%), germinoma (4.55%), and Rathke's cleft cyst (4.55%).
A nasoseptal flap was used in 7.32% of primary surgeries and 25% of reoperations. The most common combination for defect repair was abdominal fat plus bone and/or synthetic material in 45.45% of cases.
Postoperative complications included diabetes insipidus (22.73%), healthcare-associated infections (9.09%), cerebrospinal fluid fistula (7.58%), and panhypopituitarism (3.03%).
The average hospital stay for primary procedures was 16.20 days, with 4.85 days in the Pediatric Neurointensive Care Unit, compared to 15.84 days and 4.40 days, respectively, for re-operated patients. In the presented series, the median outpatient follow-up was 3 years.
CONCLUSION: Despite the challenges posed by small nasal cavities and developing paranasal sinuses in the pediatric age group, endoscopic surgery via the endonasal corridor can be successfully performed in selected cases.