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

Tsai, Eve C.; Santoreneos, Stephen; Rutka, James T.

doi:10.3171/foc.2002.12.5.2

Cited by 83 publications

(78 citation statements)

References 128 publications

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“…In general it is believed that outcomes in pediatric skull base surgery are better than in adult patients, attributed to higher rates of complete resection afforded by better tissue planes, more frequent benign pathology, and centralization in high-volume pediatric centers. 26,27 However, the need for radical resection at the cost of additional morbidity is uncertain.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…5 These lesions in the pediatric skull base can lead to severe functional impairment. 2,19 However, the unique anatomical features of the growing pediatric skull base frequently impede surgical access to local pathological entities. 5,10,18,19 Incompletely aerated sinuses or the shallow anterior fossa can hinder anterior transfacial approaches.…”

Section: Discussionmentioning

confidence: 99%

“…19 Early resection of such lesions is important, independent of decisions made for disease control, to reset the growth process. 5 These lesions in the pediatric skull base can lead to severe functional impairment.…”

Section: Discussionmentioning

confidence: 99%

Impact of skull base development on endonasal endoscopic surgical corridors

Banu

Guerrero-Maldonado

McCrea

et al. 2014

PED

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Object Scarce morphometric data exist on the developing skull base as a corridor for endonasal endoscopic approaches (EEAs). Furthermore, the impact of skull base lesions on its development has not been assessed. The authors describe a novel set of anatomical parameters characterizing the developmental process as well as the utility of these parameters in preoperative planning and a feasibility assessment of EEAs for neurosurgical treatment of skull base lesions in children. Methods Based on specific MRI sequences in 107 pediatric patients (2–16 years of age) without skull base lesions (referred to here as the normal population), 3 sets of anatomical parameters were analyzed according to age group and sex: drilling distance, restriction sites, and working distance parameters. A separate set of patients undergoing EEAs was analyzed in similar fashion to address the impact of skull base lesions on the developmental process. Results The volume of the sphenoid sinus significantly increases with age, reaching 6866.4 mm3 in the 14–16 years age group, and directly correlates with the pneumatization type (r = 0.533, p = 0.0001). The pneumatization process progresses slowly in a temporal-posterior direction, as demonstrated by the growth trend of the sellar width (r = 0.428, p = 0.0001). Nasal restriction sites do not change significantly with age, with little impact on EEAs. The intercarotid distance is significantly different only in the extreme age groups (3.9 mm, p = 0.038), and has an important impact on the transsphenoidal angle and the intracranial dissection limits (r = 0.443, p < 0.0001). The 14.9° transsphenoidal angle at 2–4 years has a 37.6% significant increase in the 11–13 years age group (p = 0.001) and is highly dependent on pneumatization type. Age-dependent differences between working parameters are mostly noted for the extreme age groups, such as the 8.6-mm increase in nare-vomer distance (p = 0.025). The nare-sellar distance is the only parameter with significant differences based on sex. Skull base lesions induce a high degree of variance in skull base measurements, delaying development and decreasing parameter values. Skull base parameters are interdependent. Nare-sellar distance can be used to assess global skull base development because it highly correlates with the intercarotid distance in both the normal population and in patients harboring skull base lesions. Conclusions Skull base development is a slow, gradual, age-dependent, sex-independent process significantly altering endonasal endoscopic corridors. Preoperative MRI measurements of the pediatric skull base are thus a useful adjunct in choosing the appropriate corridor and in assessing working angles and limits during dissection or reparative surgery. Skull base lesions can significantly impact normal skull base development and age-dependent growth patterns.

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“…Developing structures are more vulnerable to injury than the developed structures in adults, especially with regard to small and deep targets. 65 In addition, the normal anatomy of a child's brain is often altered by specific constitutional factors (e.g., malformations) or by the disease itself. Consequently, neurosurgical management of these cases requires careful preoperative planning and a high degree of intraoperative precision to correctly identify and reach the surgical target without damaging the surrounding eloquent neurovascular structures.…”

mentioning

confidence: 99%

Robot-assisted procedures in pediatric neurosurgery

Benedictis¹,

Trezza

Carai³

et al. 2017

Neurosurgical Focus

144

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OBJECTIVEDuring the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population.METHODSBetween 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging.RESULTSThe authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications.CONCLUSIONSTo the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical result, while minimizing postoperative morbidity.

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

Cited by 83 publications

References 128 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

Impact of skull base development on endonasal endoscopic surgical corridors

Robot-assisted procedures in pediatric neurosurgery

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