Endoscopic Resection of Pediatric Skull Base Tumors: An Evidence-Based Review

Kerolos Shenouda; Brian T. Yuhan; Ahsan Mir; Nathan Gonik; Jean Anderson Eloy; James K. Liu; Adam J. Folbe; Peter F. Svider

doi:10.1055/s-0038-1676305

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2019; 80(05): 527-539
DOI: 10.1055/s-0038-1676305

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Resection of Pediatric Skull Base Tumors: An Evidence-Based Review

Kerolos Shenouda

¹Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States

,

Brian T. Yuhan

¹Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States

²Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States

,

Ahsan Mir

¹Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States

,

Nathan Gonik

¹Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States

³Children's Hospital of Michigan, Detroit, Michigan, United States

,

Jean Anderson Eloy

⁴Department of Otolaryngology – Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

⁵Department of Ophthalmology and Visual Science, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

⁶Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

⁷Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

James K. Liu

⁴Department of Otolaryngology – Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

⁶Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

⁷Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Adam J. Folbe

²Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States

⁸Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States

,

Peter F. Svider

⁴Department of Otolaryngology – Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

› Author Affiliations

Abstract

Objectives To perform a systematic review examining experiences with endoscopic resection of skull base lesions in the pediatric population, with a focus on outcomes, recurrence, and surgical morbidities.

Methods PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases were evaluated. Studies were assessed for level of evidence. Bias risk was evaluated using the Cochrane Bias tool, Grades of Recommendation, Assessment, Development and Evaluation (GRADE), and Methodological Index for Non-Randomized Studies (MINORS) criteria. Patient characteristics, pathology, site of primary disease, presenting symptoms, stage, procedure specific details, and complications were evaluated. Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines.

Results Ninety-three studies met criteria for inclusion, encompassing 574 patients with skull base tumors. The GRADE and MINORS criteria determined the overall evidence to be moderate quality. The most common benign and malignant pathologies included juvenile nasopharyngeal angiofibromas (n = 239) and chondrosarcomas (n = 11) at 41.6 and 1.9%, respectively. Of all juvenile nasopharyngeal angiofibroma tumors, most presented at stage IIIa and IIIb (25.8 and 27.3%, respectively). Nasal obstruction (16.5%) and headache (16.0%) were common symptoms at initial presentation. Surgical approaches included endoscopic endonasal (n = 193, 41.2%) and endoscopic extended transsphenoidal (n = 155, 33.1%). Early (< 6 weeks) and late (>6 weeks) complications included cerebrospinal fluid leak (n = 36, 17.3%) and endocrinopathy (n = 43, 20.7%). Mean follow-up time was 37 months (0.5–180 months), with 86.5% showing no evidence of disease and 2.1% having died from disease at last follow-up.

Conclusion Endoscopic skull base surgery has been shown to be a safe and effective method of treating a variety of pediatric skull base tumors. If appropriately employed, the minimally invasive approach can provide optimal results in the pediatric population.

Keywords

pediatric - skull base - endoscopic - tumors - systematic review

Full Text

References

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Supplementary Material

Supplementary Material