Application of skull base techniques to pediatric neurosurgery

Teo, Charles; Dornhoffer, John L.; Hanna, Ehab Y.; Bower, Charles M.

doi:10.1007/s003810050343

Cited by 64 publications

(68 citation statements)

References 12 publications

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“…6,8,11,14,17,18,22,26 The largest series reported by Brockmeyer et al 6 included 55 children who underwent skull base approaches for a variety of lesions, including 41 tumors and 2 fibrous dysplasias, in addition to vascular lesions and epidural abscess. The majority of patients did well, with an 11% rate of permanent neurological morbidity.…”

Section: Discussionmentioning

confidence: 99%

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Skull base surgery for tumors in children: long-term clinical and functional outcome

Hayhurst

Williams²,

Yousaf³

et al. 2013

PED

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Object Skull base tumors in children are rare but require complex approaches with potential morbidity to the developing craniofacial skeleton, in addition to tumor-related morbidity. Reports of long-term clinical and functional outcome following skull base approaches in children are scarce. The authors report long-term outcome in children with tumors undergoing multidisciplinary skull base surgery. Methods A retrospective analysis was undertaken of children undergoing surgery at a single institution between 1998 and 2008 for benign and malignant lesions of the anterior, middle, or posterior cranial base. Patients with craniopharyngioma, pituitary tumors, and optic glioma were excluded. Histology, surgical morbidity, length of hospital stay, progression-free survival, and adjuvant therapy were recorded. Functional and cognitive outcome was assessed prospectively using the Late Effects Severity Score (LESS). Results Twenty-three children ranging in age from 13 months to 15 years underwent skull base approaches for resection of tumors during the study period. The median follow-up duration was 60 months. Tumor types included meningioma, schwannoma, rhabdomyosarcoma, neuroblastoma, angiofibroma, and chordoma. Complete resection was achieved in 12 patients (52%). Thirteen patients (57%) had benign histology. The median hospital stay was 7 days. There were 3 deaths, 1 perioperative and 2 from tumor progression. Two patients had CSF leakage (9%) and 2 developed meningitis. Two children (9%) had residual neurological deficit at last follow-up evaluation. Thirteen (59%) of 22 surviving patients received adjuvant therapy. The majority of the patients remain in mainstream education and 19 of the 20 surviving children have an LESS of 3 or lower. Conclusions Children tolerate complex skull base procedures well, with minimal surgical-related morbidity as well as good long-term tumor control rates and functional outcomes from maximal safe resection combined with adjuvant treatment when required.

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Section: Discussionmentioning

confidence: 99%

“…Teo et al 26 reviewed 26 children who underwent skull base approaches for various tumors, including schwannoma, fibrous dysplasia, chordoma, and esthesioneuroblastoma. The rate of immediate postoperative complications was 57% and permanent complications occurred in 30.7%.…”

Section: Discussionmentioning

confidence: 99%

Skull base surgery for tumors in children: long-term clinical and functional outcome

Hayhurst

Williams²,

Yousaf³

et al. 2013

PED

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“…Consistent with prior reports, there were few complications noted among patients <21 years of age. 6,7,9 When complications were encountered, they were generally less severe than those reported in older patients. For example, there were no deaths and no CNS complications noted among patients <21 compared with 9 (4.2%) deaths and 14 (6.5%) CNS complications for patients 21 years of age.…”

Section: Discussionmentioning

confidence: 95%

“…In 1999, Teo et al reported a series of 26 pediatric patients who underwent a variety of skull base approaches for the resection of benign and malignant skull base tumors. 6 Five of these patients were treated via anterior craniofacial resection for either esthesioneuroblastoma, 2 fibrous dysplasia, 2 or ossifying fibroma. 1 There were no reported complications, and 80% (4/5) of patients were alive after an average follow-up of nearly 2 years.…”

Section: Discussionmentioning

confidence: 99%

Results of Anterior Skull Base Surgery in Pediatric and Young Adult Patients

Gross¹,

Ganly²,

Patel³

et al. 2009

Skull Base

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We sought to better define the results of anterior skull base surgery in pediatric and young adult patients. We performed a single-institution, retrospective cohort study in a tertiary-care academic cancer center. Between 1973 and 2005, 234 patients underwent anterior skull base surgery at Memorial Sloan-Kettering Cancer Center. Of these, 19 patients were <21 years of age. Surgical indications, findings, and complications were reviewed. Survival outcomes were analyzed using the Kaplan-Meier method and compared with patients 21 years old. Nineteen patients <21 years old underwent a total of 20 procedures for lesions of the anterior skull base. Sarcoma was the most common indication for surgery including 6 (32%) patients treated for radiation-induced malignancies. Minor complications were noted with 6 (30%) procedures. There were no major complications and no perioperative deaths. The difference in 3-year recurrence-free (68% versus 59%; p ¼ 0.623) and overall survival (83% versus 66%; p ¼ 0.309) compared with patients 21 years old did not reach statistical significance. Anterior skull base surgery is well tolerated in pediatric and young adult patients <21 years of age. Survival is comparable to older patients treated similarly and appears strongly influenced by histology.

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“…The surgical anatomy and approaches of cranial basis of adults are well defined in literatures (Brockmeyer et al, 2003;Day et al, 1996;Lang & Samii, 1991;Ribas et al, 2005;Teo et al, 1999). The lesions that effected the cranial basis on children is rare and generally are not treated with major surgery.…”

Section: Introductionmentioning

confidence: 99%

The Localization of the Asterion According to the Anatomical Landmarks of Posterior Cranial Fossa in Newborns: Clinical Implications

et al. 2015

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SUMMARY:The purpose of this study was to determine the localization of the asterion according to the anatomical landmarks of posterior cranial fossa and its relation with sinuses for posterolateral surgical approaches in newborns. On 70 head-halves, a needle about 2 mm with diameter was placed on the centre point of asterion (posterolateral fontanel) by inserting into the whole cranial bony tissue by forming an right angle with the bony surface. Various localizations of asterion and its measurements from the internal and external anatomical landmarks were investigated on term neonatal cadavers. The localization of asterion was found as on the sigmoidtransverse sinus junction (STJ) (5., 6., 7., 8. squares) in 40% of cases on right side and in 34%, on left side. Additionally, it was located below the STJ (9., 10., 11., 12. squares) in 60% of cases, on right side and in 63% of cases on left side. We determined that the most frequent localization of asterion as the 11. square both for the right and left sides 12 (34%) cases for the right side and 11 (31,4%) cases for the left side. The asterion was not located on 1., 2., 3., 4., 5. and 12. squares on right side and 1., 3., 4., 8. and 9. squares on left side. It has been found that the region of asterion has an average distance value of 19.9 mm to internal acoustic meatus (MI), 31.7 mm to posterior clinoid process (PC), 34.4 to dorsum sellae (DS), 19.2 mm to jugular foramen (FJ), 23.0 mm to hypoglossal canal (HC), internally. The distance of asterion as 28.8 mm to zygoma root (ZR) and 22.3 mm to Henle's spine (HS) and 15.8 mm to mastoid tip (MT) and 35.9 mm to external occipital protuberance (PE) were observed. By the guide of point asterion on newborns the area of 1cm2 on this point which was placed on superior 4 squares of our scale diagram is suggested as a safe area of placement of first burr hole to avoid from the risk of bleeding of sigmoid and transverse sinuses on craniotomies of posterior fossa.

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Application of skull base techniques to pediatric neurosurgery

Cited by 64 publications

References 12 publications

Skull base surgery for tumors in children: long-term clinical and functional outcome

Skull base surgery for tumors in children: long-term clinical and functional outcome

Results of Anterior Skull Base Surgery in Pediatric and Young Adult Patients

The Localization of the Asterion According to the Anatomical Landmarks of Posterior Cranial Fossa in Newborns: Clinical Implications

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