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Endonasal endoscopic skullbase surgery in children

  • Chandrashekhar E. DeopujariEmail author
  • Nishit J. Shah
  • Salman T. Shaikh
  • Vikram S. Karmarkar
  • Chandan B. Mohanty
Focus Session

Abstract

Objective

The role of endonasal endoscopic approach for pathologies in the paediatric population is evolving and has still not been accepted as standard of care in neurosurgery. It represents a challenge in terms of narrow access, instrument manipulation and adequate reconstruction of defects. We have described our experience in 49 cases from a single neurosurgical unit in paediatric skull base surgeries through this approach over the last 12 years.

Material and methods

A case series of 59 paediatric skull base surgeries in 49 children through endoscopic endonasal route over the last 12 years is presented. The age ranges from 4 months to 18 years. Out of 49 cases, 22 cases were of craniopharyngiomas, 8 cases of pituitary adenomas, 5 cases with CSF rhinorrhea, 5 cases with meningoencephalocele, 3 cases of Rathke’s cleft cysts, 2 cases of odontoidectomy and 4 miscellaneous cases viz. mucocele, hypothalamic glioma, esthesioneuroblastoma and epidermoid. CSF leaks were repaired with free graft in the initial years and by vascularized flap more recently.

Results

The goal of surgery was achieved in all but two cases in whom the tumour excision was unsatisfactory due to failure of the cyst wall to collapse after decompression. Extent of tumour excision was not compromised by the choice of this approach. Revision surgery for CSF leak was required in three patients. Local vascularized nasoseptal flap has been possible even in very young patients and has now become the standard for reconstruction.

Conclusion

In spite of the challenges posed by small nostrils and ill-developed sinuses in the paediatric age group, surgery from endoscopic endonasal corridor is possible to be carried out successfully in selected cases.

Keywords

Endonasal Endoscopy Paediatric Skullbase 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Chandrashekhar E. Deopujari
    • 1
    Email author
  • Nishit J. Shah
    • 2
  • Salman T. Shaikh
    • 1
  • Vikram S. Karmarkar
    • 1
  • Chandan B. Mohanty
    • 1
  1. 1.Department of NeurosurgeryBombay Hospital Institute of Medical SciencesMumbaiIndia
  2. 2.Department of ENTBombay Hospital Institute of Medical SciencesMumbaiIndia

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