Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors

Elangovan, Cheran; Singh, Supriya; Gardner, Paul A.; Snyderman, Carl H.; Tyler-Kabara, Elizabeth C.; Habeych, Miguel; Crammond, Donald J.; Balzer, Jeffrey

doi:10.3171/2015.7.peds14403

Cited by 20 publications

(17 citation statements)

References 45 publications

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“…Thus, interventions addressed to reverse the significant SSEP changes by increasing perfusion, modifying or pausing the surgical procedure, might prevent neuronal death or infarction in some cases. Resection of tumors in petroclival and brainstem regions and vascular tumors such as cavernomas and hemangioblastomas are most likely to result in SSEP changes due to nerve traction and vascular injury, respectively . ICA injury is an uncommon and underreported complication of ESBS surgery.…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

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150

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Intraoperative Considerationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

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150

279

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“…12,24,30,38,40,41 Larger case series from the US have been published but were all from the same institution. 6,9,35 Among the sizable pediatric case series from American institutions, we present the longest median follow-up time of 4 years. 2,4,6,34…”

Section: Discussionmentioning

confidence: 97%

“…Transnasal endoscopic approaches in children have mostly been reported as part of larger adult-inclusive series 5,10,12,23 or as case reports, 16,18,32,33,36 but they have increasingly been described in the resection of pediatric skull base lesions. 2,4,6,9,17,30,34,40,41 Our pediatric series presents a tertiary care center's experience of implementing this surgical approach for a diverse group of sellar and suprasellar pathologies (a total of 9 different indications). Previous reports of a similar nature have been published but were either smaller in sample size 2,4,11,17,34 or conducted in a different country.…”

Section: Discussionmentioning

confidence: 99%

“…4,28 Intraoperative neuromonitoring is effective for detecting cranial nerve dysfunction during tumor dissection and can help mitigate damage to surrounding structures, and this technique is especially valuable during staged procedures and reoperations. 9 There is a distinct learning curve associated with transnasal endoscopic surgeries that must also be overcome for complex surgeries in the pediatric population. 21…”

Section: Operative Environment and Trainingmentioning

confidence: 99%

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Transnasal endoscopic approach for pediatric skull base lesions: a case series

Quon¹,

Kim²,

Hwang

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVETransnasal endoscopic transsphenoidal approaches constitute an essential technique for the resection of skull base tumors in adults. However, in the pediatric population, sellar and suprasellar lesions have historically been treated by craniotomy. Transnasal endoscopic approaches are less invasive and thus may be preferable to craniotomy, especially in children. In this case series, the authors present their institutional experience with transnasal endoscopic transsphenoidal approaches for pediatric skull base tumors.METHODSThe authors retrospectively reviewed pediatric patients (age ≤ 18 years) who had undergone transnasal endoscopic transsphenoidal approaches for either biopsy or resection of sellar or suprasellar lesions between 2007 and 2016. All operations were performed jointly by a team of pediatric neurosurgeons and skull base otolaryngologists, except for 8 cases performed by one neurosurgeon.RESULTSThe series included 42 patients between 4 and 18 years old (average 12.5 years) who underwent 51 operations. Headache (45%), visual symptoms (69%), and symptoms related to hormonal abnormalities (71%) were the predominant presenting symptoms. Improvement in preoperative symptoms was seen in 92% of cases. Most patients had craniopharyngiomas (n = 16), followed by pituitary adenomas (n = 12), Rathke cleft cysts (n = 4), germinomas (n = 4), chordomas (n = 2), and other lesion subtypes (n = 4). Lesions ranged from 0.3 to 6.2 cm (median 2.5 cm) in their greatest dimension. Gross-total resection was primarily performed (63% of cases), with 5 subsequent recurrences. Nasoseptal flaps were used in 47% of cases, fat grafts in 37%, and lumbar drains in 47%. CSF space was entered intraoperatively in 15 cases, and postoperative CSF was observed only in lesions with suprasellar extension. There were 8 cases of new hormonal deficits and 3 cases of new cranial nerve deficits. Length of hospital stay ranged from 1 to 61 days (median 5 days). Patients were clinically followed up for a median of 46 months (range 1–120 months), accompanied by a median radiological follow-up period of 45 months (range 3.8–120 months). Most patients (76%) were offered adjuvant therapy.CONCLUSIONSIn this single-institution report of the transnasal endoscopic transsphenoidal approach, the authors demonstrated that this technique is generally safe and effective for different types of pediatric skull base lesions. Favorable effects of surgery were sustained during a follow-up period of 4 years. Further refinement in technology will allow for more widespread use in the pediatric population.

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“…Indications and use of neurophysiologic monitoring have been described. 40 The surgical technique will vary based on the location of the pathology and degree of sinonasal and skull base development. The nares and pyriform aperture can be limiting in small children.…”

Section: Surgical Techniquementioning

confidence: 99%

Endoscopic Management of Developmental Anomalies of the Skull Base

Wilson

Snyderman

2018

J Neurol Surg B

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Developmental anomalies of the skull base may present in childhood or as an adult. The most common pathologies include dermoid, encephalocele, and glioma. Encephaloceles may present as part of a syndrome. Other entities include infantile hemangiomas and teratoma. Endoscopic techniques provide a less invasive and morbid option for treatment. Proper evaluation and treatment is necessary to prevent complications such as meningitis.

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Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors

Cited by 20 publications

References 45 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Transnasal endoscopic approach for pediatric skull base lesions: a case series

Endoscopic Management of Developmental Anomalies of the Skull Base

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