Pediatric endoscopic endonasal skull base surgery—where do we stand and where are we going?

Abstract

In its very essence, endoscopic neurosurgery is a perfect representation of the philosophy of minimally invasive surgery, where maximally effective procedures are performed with the least disruption of the innocent passerby normal structures. Indeed, endoscopy is currently playing a crucial role in the management of a large spectrum of neurosurgical diseases out of which many are being exclusively treated endoscopically nowadays. Compared with conventional microsurgery, one of the greatest advantages of endoscopic neurosurgery is the superior visualization of the pathoanatomical details and thus a higher probability of preservation of normal structures. Furthermore, the use of endoscope allowed precise visualization and utilization of unprecedented surgical corridors, a feature that has eminently been demonstrated in endoscopic skull base surgery. These new approaches allowed better access to many skull base pathologies and more thorough understanding of their relation to the juxtaposed neurovascular structures. Although endoscopic skull base surgery in adult patient subpopulation has now become a very well-established field, the pediatric counterpart has not fully been there yet. It was not until the late 1990s when sporadic case reports and limited series of endoscopic endonasal surgery for pediatric anterior cranial base pathologies started to appear in the literature [1, 2] and were followed by other publications. Despite the fact that many of the cranial base pathologies in children are ideal targets for endoscopic endonasal approaches, a look at the number of publications on endoscopic skull base surgery during the last two decades discloses a great discrepancy between the adult and pediatric fields. It is of note that although the surgical techniques developed for adults are also utilized in pediatric patients, the existence of specific anatomical differences between the two age groups was one of the main obstacles that have hindered the progress of pediatric endoscopic skull base surgery. Concerns in that regard included small pyriform apertures, incompletely developed nasal passages, and lacking pneumatization of the sphenoid sinus [3]. Notwithstanding, the feasibility and advantages of endoscopic transnasal access to a wide variety of midline cranial base lesions in children from the crista galli to the foramen magnum have been demonstrated [4], even in the very young pediatric age [5]. From another perspective, concerns about the craniofacial development after endoscopic endonasal skull base procedures in children turned to be unfounded as recent works disclosed no evidence of impact of endoscopic endonasal surgery on craniofacial development in the young patients [6]. In this focus session of Child’s Nervous System, we endeavored to present a constellation of papers geared * Waleed A. Azab [email protected]