The development of a pediatric skull base team: how, where and why?

Abstract

Purpose of review The purpose of this review is to describe the development of pediatric skull base surgical techniques and illustrate the advantages of pediatric endonasal skull base surgery (ESBS) when applied in appropriate settings. Additionally, this manuscript endeavors to define the pediatric skull base team components, highlight circumstances amenable to the development of a pediatric skull base surgery team, and describe the relative advantages of independent pediatric teams versus incorporation with adult skull base practices. Recent findings Multiple series published within the last decade have described the application of ESBS to the pediatric population, demonstrating adoption of these interventions in many academic centers. Most series include relatively small numbers of patients, highlighting the relative infrequency of anterior skull base pathology in the pediatric patient. Given the relatively low volume and high technical demands of this skillset, general guidelines for the timing, suggested training, and volume necessary to support a pediatric skull base team are offered. Summary The interest in pediatric ESBS continues to expand though case volumes may limit maintenance of skills in lower volume centers. The development of a dedicated pediatric skull base team in areas where sufficient volume exists facilitates concentration of expertise and interdisciplinary relationships necessary to provide the highest level of care. Collaborating with adult skull base teams can enhance the pediatric team experience, increasing exposure to complex surgical planning and radiologic nuances. However, a pediatric-focused skull base team can tailor treatment to meet the specific psychosocial and developmental needs of children.

A Multidisciplinary Skull Base Board for Tumour and Non-Tumour Diseases: Initial Experiences

“…It is known that a sufficient influx of these patients is crucial for the quality treatment of skull base diseases [5,7]. In comparison with international data, we believe that a comparable number of patients with skull base diseases were treated in our tertiary institution, ensuring high-quality care.…”

“…The MDT-SB includes the management of the paediatric population in addition to adults. For the best results in treating children with skull base diseases, it is recommended to handle at least one case per month [7], which, according to MDT-SB data, we did not achieve. However, based on unpublished data, the number of treated children exceeded this number, as they were treated outside of the MDT-SB.…”

“…Specialised understanding of skull base anatomy, diagnostic and therapeutic options, and awareness of the latest research or discoveries supporting and guiding patient care are crucial. Key representatives of the MDT-SB (regular members) in our institution include an otolaryngologist, neurosurgeon, and neuroradiologist, which is comparable to foreign institutions [7] (Table 2). During individual preparation for the consultation, regular members may invite specialists from other fields as needed.…”

Special Considerations in Pediatric Endoscopic Skull Base Surgery

“…Without such centers and patient care standardization, treatment variations may be influenced by individual physicians' training and preferences. Multi-institutional collaboration aids in disseminating current techniques, boosting the technical proficiency of pediatric surgical teams [2].…”

“…Inherent anatomic differences between these patient populations form the focal point of these discussions. Due to intricate complexities involving perioperative management as well as disease surveillance, management of pediatric patients with skull base disorders requires a multidisciplinary approach [1,2].…”