Endoscopic Skull Base Surgery among Pediatric Patients: A 14-Year Review

Introduction: The need for endoscopic skull base surgery among pediatric patients is rare and unique factors must be considered when treating this patient population. The main objectives of this study were to determine the indications for and outcomes following endoscopic skull base surgery among pediatric patients.

Methods: A retrospective analysis was performed on individuals who underwent endoscopic skull base surgery at a tertiary care center from 2009 to 2023. Patients <18 years of age were included and compared to patients ≥18 years of age. Patient characteristics, clinical history, and outcomes were collected. Statistical analysis was performed with Prism GraphPad (v10.0.2). Fisher’s exact test and t-test were used, as indicated.

Results: Thirty-three pediatric and 31 adult patients were included. The mean age was 14.7 years for pediatric patients and 69.3 years for adult patients. All pediatric and adult patients were treated with an endoscopic endonasal approach; 31 (93.9%) pediatric and 30 (96.7%) adult patients underwent primary resection and two (6.1%. pediatric patients and one (3.2%) adult patient underwent revision surgery (p > 0.99). Two pediatric patients (6.1%) and zero adult patients (0.0%) were previously treated with radiation (p = 0.49). The most common pathologic diagnoses in pediatric patients were pituitary adenoma (33.3%), Rathke’s cleft cyst (21.2%), and craniopharyngioma (18.2%); all adult patients had pituitary adenomas, and the most common pathologic diagnosis was a clinically nonfunctional adenoma (77.4%). Gross-total and near-total resections as determined by postoperative magnetic resonance imaging were achieved in 69.7% and 12.1% of cases, respectively, for pediatric patients, and 65.4% and 15.4% of cases, respectively, for adult patients. An intraoperative cerebrospinal fluid (CSF) leak was present in 17 (51.5%) pediatric cases and 13 (41.9%) adult cases (p = 0.46). A postoperative CSF leak was present in one (3.0%) pediatric case and one (3.2%) adult case (p > 0.99). The mean length of stay in the hospital after surgery was 4.6 days (SD = 5.2. for pediatric patients and 3.7 days (SD = 5.6. for adult patients (p = 0.48).

Conclusion: Endoscopic skull base surgery is uncommon among pediatric patients and can be challenging given their underdeveloped anatomical structures. In this study, the most common indication for surgery among both pediatric and adult patients was for a pituitary adenoma. The intraoperative CSF leak rate was high at 51.5% and 41.9% in pediatric and adult patients, respectively, but postoperative CSF leaks were rare. The mean length of stay in the hospital after surgery was similar among pediatric and adult patients.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024