Paediatric endoscopic endonasal middle skull base reconstruction: retrospective analysis of 78 patients treated in a single tertiary care paediatric center

Abstract

Introduction

Skull base pathologies in the paediatric population are rare and require treatment by multiple qualified specialists. The endoscopic endonasal approach has revolutionized surgical treatment because it is less invasive than existing treatments.The goal of this study was to retrospectively review our experience with the reconstruction of paediatric skull middle base defects and associated complications.

Materials and methods

We analysed medical records from patients aged ≤ 18 years who were treated at our centre between 2013 and 2021. Patients treated with an endoscopic skull base approach and reconstruction, and who had complete clinical and radiological documentation and a minimum follow-up of 12 months, were included in the analysis. Personal data, reconstructive techniques, and complications were analysed.

Results

A total of 78 patients met the inclusion criteria and were enrolled in the study. Of these patients, 32 were male and 46 were female, and the mean age was 11.5 years. The main signs and symptoms were as follows: bitemporal hemianopsia in 53 cases, visual impairment in 23 cases, and headache in 30 cases. The most frequent aetiologies were craniopharyngioma (38 cases), pituitary adenoma (23 cases), and clivus chordoma (4 cases). All patients were treated via a pure endoscopic approach. For reconstruction, a multilayer technique was used in 18 cases, naso-septal flap in 43 cases, Gasket-Seal technique in 12 cases, and heterologous reconstruction in 5 cases. Only six patients presented a major complication: two had a postoperative cerebral spinal fluid leak, one developed a brain abscess, and three had diabetes insipidus.The mean follow-up period was 23.4 months.There were no statistically significant differences in postoperative CSF leak in relation to different reconstructive techniques.

Conclusion

Endoscopic endonasal skull base surgery is a safe and effective treatment for paediatric middle skull base pathologies. Reconstruction techniques have a high success rate of 96.5–100%, and the rate of associated complications is < 3%.

Keywords:

• Pediatric skull base surgery
• skull base reconstruction
• endonasal endoscopy
• middle skull base

Authors’ contributions

Di Giorgio Danilo: design of the work; interpretation of data for the work; Final approval of the version to be published. Giovannetti Filippo: design of the work; interpretation of data for the work; Final approval of the version to be published. Priore Paolo: Acquisition, analysis, and interpretation of data for the work. Scagnet Mirko: Substantial contributions to interpretation of data for the work, Final approval. Mussa Federico: Substantial contributions to interpretation of data for the work, Final approval. Raponi Ingrid: Acquisition, analysis, and interpretation of data for the work. Valentini Valentino: design of the work; interpretation of data for the work; Final approval of the version to be published. Genitori Lorenzo: design of the work; interpretation of data for the work; Final approval of the version to be published. Data Availability Statement: Data cannot be shared for confidentiality reasons. Queries about the data should be directed to the corresponding author.

Ethics statement

Ethical approval was not required for this study in accordance with national guidelines. Written informed consent was obtained from the parent/legal guardian of the patient for publication of the details of their medical case and any accompanying images

Disclosure statement

All authors (Di Giorgio Danilo, Giovannetti Filippo, Priore Paolo, Scagnet Mirko, Mussa Federico, Raponi Ingrid, Valentini Valentino, Genitori Lorenzo) certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.