Endoscopic approaches to the cranial base: perspectives and realities

Locatelli, Davide; Castelnuovo, Paolo; Santi, L.; Cerniglia, M.; Maghnie, Mohamad; Infuso, L

doi:10.1007/s003810000323

Cited by 51 publications

(30 citation statements)

References 13 publications

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“…16,20,25 Because a large proportion of pediatric skull base pathology arises in the anterior cranial fossa, 8,14 endoscopic endonasal approaches are likely to play an increasing role. 24 Pathologies specific to the pediatric population such as juvenile nasopharyngeal angiofibroma are increasingly managed entirely endoscopically, with case series demonstrating excellent local tumor control.…”

Section: Hanbali Et Almentioning

confidence: 99%

Skull base surgery for tumors in children: long-term clinical and functional outcome

Hayhurst

Williams²,

Yousaf³

et al. 2013

PED

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Object Skull base tumors in children are rare but require complex approaches with potential morbidity to the developing craniofacial skeleton, in addition to tumor-related morbidity. Reports of long-term clinical and functional outcome following skull base approaches in children are scarce. The authors report long-term outcome in children with tumors undergoing multidisciplinary skull base surgery. Methods A retrospective analysis was undertaken of children undergoing surgery at a single institution between 1998 and 2008 for benign and malignant lesions of the anterior, middle, or posterior cranial base. Patients with craniopharyngioma, pituitary tumors, and optic glioma were excluded. Histology, surgical morbidity, length of hospital stay, progression-free survival, and adjuvant therapy were recorded. Functional and cognitive outcome was assessed prospectively using the Late Effects Severity Score (LESS). Results Twenty-three children ranging in age from 13 months to 15 years underwent skull base approaches for resection of tumors during the study period. The median follow-up duration was 60 months. Tumor types included meningioma, schwannoma, rhabdomyosarcoma, neuroblastoma, angiofibroma, and chordoma. Complete resection was achieved in 12 patients (52%). Thirteen patients (57%) had benign histology. The median hospital stay was 7 days. There were 3 deaths, 1 perioperative and 2 from tumor progression. Two patients had CSF leakage (9%) and 2 developed meningitis. Two children (9%) had residual neurological deficit at last follow-up evaluation. Thirteen (59%) of 22 surviving patients received adjuvant therapy. The majority of the patients remain in mainstream education and 19 of the 20 surviving children have an LESS of 3 or lower. Conclusions Children tolerate complex skull base procedures well, with minimal surgical-related morbidity as well as good long-term tumor control rates and functional outcomes from maximal safe resection combined with adjuvant treatment when required.

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Section: Hanbali Et Almentioning

confidence: 99%

Skull base surgery for tumors in children: long-term clinical and functional outcome

Hayhurst

Williams²,

Yousaf³

et al. 2013

PED

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“…68 The transsphenoidal approach has many variations including a sublabial transnasal dissection, perinasal, transethmoid, pure transnasal, and endoscopic. 75,129,135 Transsphenoidal surgery in children may be limited by virtue of the small sella and the absence of a fully aerated sphenoid sinus. In such cases, image guidance may be invaluable for keeping the neurosurgeon directly on the midline when approaching the sella.…”

Section: Neurosurg Focus / Volume 12 / May 2002mentioning

confidence: 99%

“…64 The classic transspenoidal approach involves a sublabial transnasal dissection; however, several modifications have been described involving a perinasal, transethmoid, pure transnasal, microsurgical, or endoscopic technique. 26,75,129,135 Complications associated with the transsphenoidal technique have already been described. …”

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confidence: 99%

“…75,129,135 88 In cases of lesions of the paracentral middle fossa, patients can develop intractable facial pain and dysesthesia, and tumors can affect the optic nerve in the apex, third through sixth cranial nerves, temporal and frontal lobes, and the cavernous carotid artery. 88 Lateral middle fossa lesions affect the divisions of the trigeminal nerve, lateral orbit, and infratemporal fossa and can cause facial deformity and oropharyngeal obstruction.…”

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confidence: 99%

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Tumors of the skull base in children: review of tumor types and management strategies

Tsai¹,

Santoreneos²,

Rutka³

2002

FOC

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Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.

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“…Mais recentemente, com outros avanços tecnológicos, como neuronavegação e a ultrassonografia microvascular com doppler, a cirurgia transesfenoidal foi expandida para além dos limites da sela túrcica, introduzindo o conceito de acessos estendidos à base do crânio (Locatelli et al, 2000;Kaptain et al, 2001;Jho et al, 2004).…”

Section: Cirurgia Endoscópica Endonasal E Da Base Anterior Do Crâniounclassified

Estudo das relações da artéria frontobasilar medial com a base anterior do crânio através de angiotomografia computadorizada

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Endoscopic approaches to the cranial base: perspectives and realities

Cited by 51 publications

References 13 publications

Skull base surgery for tumors in children: long-term clinical and functional outcome

Skull base surgery for tumors in children: long-term clinical and functional outcome

Tumors of the skull base in children: review of tumor types and management strategies

Estudo das relações da artéria frontobasilar medial com a base anterior do crânio através de angiotomografia computadorizada

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