Pediatric anterior skull base tumors: Our experience and review of literature

Abstract

Surgery for skull base lesions has advanced considerably in the past few years. The improvement in surgical results could be attributed to the availability of refined imaging modalities, modern technological advances and multidisciplinary team approach. In this report, we present our personal experience in the surgical management of 45 children with a variety of skull base lesions treated over 10 years. This article includes a retrospective analysis of the surgical approaches used and their results with a review of the literature.

The Pediatric Anterior Skull Base: An Otolaryngologist's Perspective

“…Other clinical manifestations noted in the literature include recurrent sinus infection, headache, and heaviness of the head. 4,5 Physical exam includes a thorough cranial nerve exam as a well as an endoscopic exam. Hanbali et al 4 found that the most common clinical findings in children with skull base lesions requiring resection included decreased facial sensation, restricted ocular motility, decreased visual acuity, and proptosis.…”

“…Chemotherapy has not been useful for solid tumors of the skull base in children, other than for rhabdomyosarcoma. 5 Cranial radiotherapy, be it external beam or brachytherapy, is frequently used as adjuvant therapy in adults with solid tumors of the skull base. However, it has a more limited role in children because of concerns for generalized growth retardation, pituitary insufficiency and its associated hormonal disturbances, and irreversible visual consequences due to proximity of the orbit.…”

“…18 The development of endoscopic technique and image-guided computer-assisted surgery has revolutionized the surgical management of skull base tumors, and endonasal surgery has become the procedure of choice, primarily for midline lesions. 5,10 With improved technology, angled scopes, image guidance systems, and high-speed drills, it is now possible to access the midline skull base from the frontal sinus to the second cervical vertebra and from the sella to the jugular foramen endoscopically 5,10,18 (Fig. 4).…”

“…However, with the advancement of skull base surgery and endoscopic techniques, previously unresectable lesions can now be managed surgically, and the role of the otolaryngologist is increasing, especially for those lesions involving the anterior cranial fossa. Diagnosis and management of skull base tumors are well described in adults, but only a few reports [1][2][3][4][5] exist pertaining to the pediatric population, primarily because skull base tumors are generally uncommon but even rarer in children. 1,6 In adults, meningiomas and sinonasal malignancies are the most common anterior skull base lesions, whereas fibrous dysplasia, esthesioneuroblastomas, and 10.5005/jp-journals-10001-1280 encephaloceles predominate in children.…”

Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors

“…5,18,19,32,41 For properly selected tumors, EES offers several advantages over traditional methods, including the sparing of disfiguring facial incisions and craniotomy. EES allows the surgeons to access the entire ventral skull base, from the crista galli to the upper cervical spine, with minimal postoperative complications.…”