Pediatric skull base tumors: A management challenge

Abstract

A BSTRACT Context: Skull base tumors are varied in children and are particularly challenging to pediatric neurosurgeons, with few papers in the literature describing the evolution, complications, and outcome. The authors evaluated long-term outcomes in children submitted to skull base tumor surgery and performed a literature review. Aims: The aim of this study was to analyze surgical results, complications, and outcomes, on comparison with previous publications. Materials and Methods: A retrospective analysis of children undergoing surgery at a single institution between 2000 and 2018 for lesions of the cranial base was carried out. In addition, a literature review was carried out describing a total of 115 children operated on for skull base tumors. Statistical Analysis: Chi-squared and Fisher’s exact tests were performed to compare the distribution of categorical variables and a nonparametric Mann–Whitney U test was used to perform intergroup comparisons of continuous variables. Results: Seventeen children ranging in age from 8 months to 17 years (mean, 10.9 years) underwent skull base approaches. Tumor types included schwannoma, meningioma, chondroid chordoma, mature teratoma, epidermoid cyst, hemangiopericytoma, rhabdomyosarcoma, myofibroblastic inflammatory tumor, fibromyxoid sarcoma, Crooke’s cell adenoma, ossifying fibroma, osteoblastoma, nasopharyngeal angiofibroma and Ewing’s sarcoma. Gross total resection was achieved in 6 patients (35.3%), 12 patients (70.6%) had benign histology, and 5 patients (29.4%) had a malignant tumor. Transient postoperative cerebrospinal fluid leak affected only one patient. Thirteen children (76.4%) had a residual neurological deficit at last follow-up evaluation. Three (17.6%) surviving patients received adjuvant therapy. The rate of recurrence or lesion progression was 17.6%. Conclusions: Skull base tumors in children present a therapeutic challenge because of their unique pathological composition and can lead to considerable morbidity and mortality in pediatric age.

Trans-eyebrow supraorbital endoscope-assisted keyhole approach to suprasellar meningioma in pediatric patient: case report and literature review

“…The trans-eyebrow supraorbital keyhole approach becomes a safe alternative for the patient with anterior midline tumors and meningiomas, especially in cases where the parasellar structures are dislocated upwards and there is an alteration of vision [ 35 , 36 ]. The risk of CSF leakage is absent compared to the transsphenoidal approach and overall postoperative morbidity appears to be less severe.…”

Neurosurgical Management of Skull Base Epidermoid Tumors in Children

“…Small ET can be resected with the translabyrinthine approach, but in the attempt to audition and facial CN preservation, the retrolabyrinthine approach can be done. Also, mastoidectomy can be performed [2][3][4][5][6][7][8][9][10]. Some structures that ET can reach are neurovascular structures, CN, perforating arteries, veins, and brainstem [3].…”

“…The CT shows a low-density lesion without enhancement. The MRI presents hypointense cists in T1-weighted and hyperintense in T2-weighted [ 4 - 10 ]. This appearance is similar to those found in arachnoid cyst imaging [ 1 , 4 - 5 , 10 ].…”

“…The MRI presents hypointense cists in T1-weighted and hyperintense in T2-weighted [ 4 - 10 ]. This appearance is similar to those found in arachnoid cyst imaging [ 1 , 4 - 5 , 10 ].…”

Hyperostosis in orbital rhabdomyosarcoma

“…Imaging will show a thickened sphenoid, usually the greater wing, with a surrounding soft-tissue mass. Skull base meningiomas are very rare in the paediatric population, comprising less than 5% of all paediatric brain tumours 11 12…”