Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients

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Object

The authors reviewed their experience with endoscopic approaches to determine their safety and efficacy in the treatment of pediatric patients who harbor skull base lesions. Although they were interested in ascertaining outcomes after surgery as well as validating and defining indications and limitations of these approaches, the authors recognized that the follow-up duration was inadequate to assess long-term outcomes.

Methods

The authors conducted a retrospective review of all endoscopic procedures performed at their institution between January 2000 and September 2005. The procedures were categorized into a series of anatomical modular approaches.

Twenty-five patients 18 years of age or younger were identified. The surgical goals were individualized and included gross-total resection, partial resection, biopsy, decompression of neural structures, and repair of a cerebrospinal fluid (CSF) leak. One patient required an open procedure in addition to the expanded endonasal approach for definitive therapy. No patient suffered a neurological deficit, vascular injury, or central nervous system infection. A CSF leak was the most common complication and occurred in two (8%) of the 25 patients.

Conclusions

In well-selected patients, the expanded endonasal approach represents a safe, effective, and minimally invasive technique for the treatment of skull base lesions in children. Incremental experience is needed for acquiring the skills with endoscopic techniques to progress to the more complex modular approaches.

Abbreviations used in this paper:

AVM = arteriovenous malformation; CA = carotid artery; CSF = cerebrospinal fluid; CT = computed tomography; ICA = internal CA; MR = magnetic resonance; OCR = opticocarotid recess; VA = vertebral artery.

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Contributor Notes

Address reprint requests to: Amin Kassam, M.D., Department of Neurological Surgery, UPMC Presbyterian, 200 Lothrop Street, Suite B-400, Pittsburgh, Pennsylvania 15213. email: kassamab@upmc.edu.
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