title: Endoscopic endonasal skull base surgery in the pediatric population.
abstract: OBJECTIVE
  The use of endoscopic endonasal surgery (EES) for skull base pathologies in the pediatric population presents unique challenges and has not been well described. The authors reviewed their experience with endoscopic endonasal approaches in pediatric skull base surgery to assess surgical outcomes and complications in the context of presenting patient demographics and pathologies.
  
  
  METHODS
  A retrospective review of 133 pediatric patients who underwent EES at our institution from July 1999 to May 2011 was performed.
  
  
  RESULTS
  A total of 171 EESs were performed for skull base tumors in 112 patients and bony lesions in 21. Eighty-five patients (63.9%) were male, and the mean age at the time of surgery was 12.7 years (range 2.3-18.0 years). Skull base tumors included angiofibromas (n = 24), craniopharyngiomas (n = 16), Rathke cleft cysts (n = 12), pituitary adenomas (n = 11), chordomas/chondrosarcomas (n = 10), dermoid/epidermoid tumors (n = 9), and 30 other pathologies. In total, 19 tumors were malignant (17.0%). Among patients with follow-up data, gross-total resection was achieved in 16 cases of angiofibromas (76.2%), 9 of craniopharyngiomas (56.2%), 8 of Rathke cleft cysts (72.7%), 7 of pituitary adenomas (70%), 5 of chordomas/chondrosarcomas (50%), 6 of dermoid/epidermoid tumors (85.7%), and 9 cases of other pathologies (31%). Fourteen patients received adjuvant radiotherapy, and 5 received chemotherapy. Sixteen patients (15.4%) showed tumor recurrence and underwent reoperation. Bony abnormalities included skull base defects (n = 12), basilar invagination (n = 4), optic nerve compression (n = 3) and trauma (n = 2); preexisting neurological dysfunction resolved in 12 patients (57.1%), improved in 7 (33.3%), and remained unchanged in 2 (9.5%). Overall, complications included CSF leak in 14 cases (10.5%), meningitis in 5 (3.8%), transient diabetes insipidus in 8 patients (6.0%), and permanent diabetes insipidus in 12 (9.0%). Five patients (3.8%) had transient and 3 (2.3%) had permanent cranial nerve palsies. The mean follow-up time was 22.7 months (range 1-122 months); 5 patients were lost to follow-up.
  
  
  CONCLUSIONS
  Endoscopic endonasal surgery has proved to be a safe and feasible approach for the management of a variety of pediatric skull base pathologies. When appropriately indicated, EES may achieve optimal outcomes in the pediatric population.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Chivukula
authors.forename: Maria
authors.initials: M
authors.lastname: Koutourousiou
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernandez-Miranda
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tyler-Kabara
mesh_terms: D000293:Adolescent; D001847:Bone Diseases / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D016896:Treatment Outcome