Neurotologic skull base surgery in pediatric patients.
OBJECTIVE
Innovations in diagnosis, surgical techniques, and perioperative care have dramatically improved outcomes in lateral skull base procedures in recent years. There is a belief, however, that children with skull base tumors have yet to benefit from these technological and procedural advances. The purpose of this study is to provide a clinical review of neurotologic skull base surgery in the pediatric population.


METHODS
Retrospective case review.


METHODS
Private practice tertiary referral center.


METHODS
Eighty-nine pediatric patients undergoing 115 neurotologic procedures for lateral skull base tumors from July 1992 to September 2003.


METHODS
Initial clinical presentation, tumor type, pre- and postoperative hearing and facial nerve status, treatment course, complications, and functional outcomes.


RESULTS
The majority of tumors in this series were vestibular schwannomas, and 65 patients were diagnosed with neurofibromatosis Type 2. Surgical approaches included 70 middle fossa, 40 translabyrinthine, 2 transcochlear, 2 infratemporal fossa, and 1 retrosigmoid craniotomy. Complete tumor removal was accomplished in the majority of cases (97%), with good preservation of facial nerve function (House-Brackmann Grade I or II) in 80% of patients. In patients undergoing middle fossa surgery for hearing preservation, measurable hearing was preserved in 61.4% of cases. The incidence of complications was low.


CONCLUSIONS
With advances in diagnostic procedures and use of current neurotologic techniques, pediatric patients may undergo successful treatment of lateral skull base tumors, with good functional outcomes and minimal morbidity.
Cunningham
Calhoun D
CD
House Ear Clinic and House Ear Institute, Los Angeles, California, USA.
Friedman
Rick A
RA
Brackmann
Derald E
DE
Hitselberger
William E
WE
Lin
Harrison W
HW
D000293:Adolescent; D001301:Audiometry, Pure-Tone; D002648:Child; D003399:Craniotomy / Q000379:methods; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D008297:Male; D016518:Neurofibromatosis 2 / Q000601:surgery*; D009464:Neuroma, Acoustic / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013063:Speech Discrimination Tests