Outcomes of Endoscopic Versus Open Skull Base Surgery in Pediatric Patients

Laryngoscope. 2021 May;131(5):996-1001. doi: 10.1002/lary.29127. Epub 2020 Nov 2.

Abstract

Objective/hypothesis: To characterize the pathology and outcomes of skull base surgery in the pediatric population by open versus endoscopic surgical approach.

Study design: Retrospective cohort study.

Methods: A retrospective review of pediatric patients (<18 years) who underwent skull base surgery for nonmalignant disease from May 2000 to August 2019 was performed. Patient demographics, pathology, and operative characteristics by surgical approach were recorded and analyzed. Patients with a combined endoscopic/open approach were classified as open for the analysis.

Results: Eighty-two pediatric skull base patients were identified with a mean age of 11.3 years (standard deviation 5.2). A purely endoscopic approach was used in 63 (77%) patients, a purely open approach was used in nine (11%) patients, and a combined open/endoscopic approach was used in 10 (12%) patients. The all-cause complication rate was 9.8%. There was no statistically significant difference in rate of complications between patients with an open versus endoscopic approach for resection (15.8% vs. 7.9%; P = .379). Risk of having a complication did not significantly vary by patient age. The odds of having a complication with an open approach was not statistically significant in a multivariable model adjusted for age, sex, race, intraoperative cerebrospinal fluid leak, tracheostomy requirement, and vascular flap use (odds ratio 2.76, 95% confidence interval 0.28-26.94; P = .383).

Conclusions: Our retrospective study demonstrates a similar risk of complication for open versus endoscopic approach to resection in pediatric skull base patients at our institution. Safety and feasibility of the endoscopic approach has previously been demonstrated in children, and this is the first study to directly compare outcomes with open approaches.

Level of evidence: 4 Laryngoscope, 131:996-1001, 2021.

Keywords: Skull base; complications; pediatrics; safety; surgical procedures.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Factors
  • Cerebrospinal Fluid Leak / epidemiology*
  • Cerebrospinal Fluid Leak / etiology
  • Child
  • Child, Preschool
  • Encephalocele / surgery
  • Endoscopy / adverse effects*
  • Endoscopy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Intraoperative Complications / epidemiology*
  • Intraoperative Complications / etiology
  • Male
  • Neurosurgical Procedures / adverse effects*
  • Neurosurgical Procedures / methods
  • Perforator Flap / statistics & numerical data
  • Perforator Flap / transplantation
  • Pituitary Diseases / surgery
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Skull Base / injuries
  • Skull Base / pathology
  • Skull Base / surgery*
  • Skull Base Neoplasms / diagnosis
  • Skull Base Neoplasms / pathology
  • Skull Base Neoplasms / surgery
  • Tracheostomy / statistics & numerical data
  • Treatment Outcome