Endonasal endoscopic skullbase surgery in children

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



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.


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.


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.


Endonasal Endoscopy Paediatric Skullbase 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Weiss DD, Robson CD, Mulliken JB (1998) Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 102(6):2119–2123CrossRefGoogle Scholar
  2. 2.
    Van Den Abbeele T, Elmaleh M, Herman P, Francois M, Narcy P (1999) Transnasal endoscopic repair of congenital defects of the skull base in children. Arch Otolaryngol Head Neck Surg 125(5):580–584CrossRefGoogle Scholar
  3. 3.
    Jorissen M, Eloy P, Rombaux P, Bachert C, Daele J (2000) Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma. Acta Otorhinolaryngol Belg 54(2):201–219Google Scholar
  4. 4.
    Ma YX, Zhang WJ, Yan ZH, He JW, Cheng XJ, Wang YJ, Zhang CB, He L (2013) Normal pneumatization time of paranasal sinuses in 799 children: evaluation with magnetic resonance imaging. Zhonghua Yi Xue Za Zhi 93(11):816–818Google Scholar
  5. 5.
    Tatreau JR, Patel MR, Shah RN, McKinney KA, Wheless SA, Senior BA, Ewend MG, Germanwala AV, Ebert CS Jr, Zanation AM (2010) Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients. Laryngoscope 120(9):1730–1737CrossRefGoogle Scholar
  6. 6.
    Banu MA, Rathman A, Patel KS, Souweidane MM, Anand VK, Greenfield JP, Schwartz TH (2014) Corridor-based endonasal endoscopic surgery for pediatric skull base pathology with detailed radioanatomic measurements. Neurosurgery 10(Suppl 2):273–293 discussion 293CrossRefGoogle Scholar
  7. 7.
    Chen W, Gardner PA, Branstetter BF, Liu SD, Chang YF, Snyderman CH, Goldstein JA, Tyler-Kabara EC, Schuster LA (2019) Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth. J Neurosurg Pediatr 11:1–8Google Scholar
  8. 8.
    Keshri AK, Shah SR, Patadia SD, Sahu RN, Behari S (2016) Transnasal endoscopic repair of pediatric meningoencephalocele. J Pediatr Neurosci 11(1):42–45CrossRefGoogle Scholar
  9. 9.
    Partington MD, Davis DH, Laws ER Jr, Scheithauer BW (1994) Pituitary adenomas in childhood and adolescence. Results of transsphenoidal surgery. J Neurosurg 80(2):209–216CrossRefGoogle Scholar
  10. 10.
    Dyer EH, Civit T, Visot A, Delalande O, Derome P (1994) Transsphenoidal surgery for pituitary adenomas in children. Neurosurgery 34(2):207–212 discussion 212CrossRefGoogle Scholar
  11. 11.
    Zhan R, Xu G, Wiebe TM, Li X (2015) Surgical outcomes of the endoscopic transsphenoidal route to pituitary tumours in paediatric patients >10 years of age: 5 years of experience at a single institute. Arch Dis Child 100(8):774–778CrossRefGoogle Scholar
  12. 12.
    Zada G, Laws ER (2010) Surgical management of craniopharyngiomas in the pediatric population. Horm Res Paediatr 74(1):62–66CrossRefGoogle Scholar
  13. 13.
    Patel VS, Thamboo A, Quon J, Nayak JV, Hwang PH, Edwards M, Patel ZM (2017) Outcomes after endoscopic endonasal resection of craniopharyngiomas in the pediatric population. World Neurosurg 108:6–14CrossRefGoogle Scholar
  14. 14.
    Locatelli D, Massimi L, Rigante M, Custodi V, Paludetti G, Castelnuovo P, Di Rocco C (2010) Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 74(11):1298–1302CrossRefGoogle Scholar
  15. 15.
    Locatelli D, Levi D, Rampa F, Pezzotta S, Castelnuovo P (2004) Endoscopic approach for the treatment of relapses in cystic craniopharyngiomas. Childs Nerv Syst 20(11–12):863–867CrossRefGoogle Scholar
  16. 16.
    Massimi L, Rigante M, D'Angelo L, Paternoster G, Leonardi P, Paludetti G, Di Rocco C (2011) Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgery. Acta Neurochir (Wien) 153(4):843–849CrossRefGoogle Scholar
  17. 17.
    Deopujari CE, Karmarkar VS, Shah N, Vashu R, Patil R, Mohanty C, Shaikh S (2018) Combined endoscopic approach in the management of suprasellar craniopharyngioma. Childs Nerv Syst 34(5):871–876CrossRefGoogle Scholar
  18. 18.
    Kassam AB, Snyderman C, Gardner P, Carrau R, Spiro R (2005) The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery 57(1 Suppl):E213 discussion E213Google Scholar
  19. 19.
    Beech TJ, McDermott AL, Kay AD, Ahmed SK (2012) Endoscopic endonasal resection of the odontoid peg--case report and literature review. Childs Nerv Syst 28(10):1795–1799CrossRefGoogle Scholar
  20. 20.
    Patel AJ, Boatey J, Muns J, Bollo RJ, Whitehead WE, Giannoni CM, Jea A (2012) Endoscopic endonasal odontoidectomy in a child with chronic type 3 atlantoaxial rotatory fixation: case report and literature review. Childs Nerv Syst 28(11):1971–1975CrossRefGoogle Scholar
  21. 21.
    Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC (2013) Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11(3):227–241CrossRefGoogle Scholar
  22. 22.
    Stapleton AL, Tyler-Kabara EC, Gardner PA, Snyderman CH, Wang EW (2017) Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery. Int J Pediatr Otorhinolaryngol 93:163–166CrossRefGoogle Scholar
  23. 23.
    Shah RN, Surowitz JB, Patel MR, Huang BY, Snyderman CH, Carrau RL, Kassam AB, Germanwala AV, Zanation AM (2009) Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 119(6):1067–1075CrossRefGoogle Scholar
  24. 24.
    Purcell PL, Shinn JR, Otto RK, Davis GE, Parikh SR (2015) Nasoseptal flap reconstruction of pediatric sellar defects: a radiographic feasibility study and case series. Otolaryngol Head Neck Surg 152(4):746–751CrossRefGoogle Scholar
  25. 25.
    El-Bosraty HM, Shehata W (2013) Endoscopic reconstruction of skull base defects using a nasal septal flap in paediatric patients. Egypt J Otolaryngol 29:159–165Google Scholar
  26. 26.
    Khalili S, Palmer JN, Adappa ND (2015) The expanded endonasal approach for the treatment of intracranial skull base disease in the pediatric population. Curr Opin Otolaryngol Head Neck Surg 23(1):65–70Google Scholar

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

Personalised recommendations