Outcomes in Pediatric Endoscopic Skull Base Surgery: A Systematic Review

Erin M Lopez; Zainab Farzal; Kelly M Dean; Craig Miller; Justin C Morse; Charles S Ebert Jr; Adam J Kimple; Brian D Thorp; Adam M Zanation

doi:10.1055/a-1725-9151

Outcomes in Pediatric Endoscopic Skull Base Surgery: A Systematic Review

J Neurol Surg B Skull Base. 2022 Jan 16;84(1):24-37. doi: 10.1055/a-1725-9151. eCollection 2023 Feb.

Authors

Erin M Lopez¹, Zainab Farzal¹, Kelly M Dean¹, Craig Miller¹, Justin C Morse¹, Charles S Ebert Jr¹, Adam J Kimple¹, Brian D Thorp¹, Adam M Zanation¹

Affiliation

¹ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Memorial Hospitals, Chapel Hill, North Carolina, United States.

Abstract

Objectives The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study aims to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents aged 0 to 18 years. Design A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000 to 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Final inclusion criteria included: case series with more than 10 patients with pediatric patients aged ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting This study was conducted at a tertiary care medical center. Participants Children/adolescents aged 0 to 18 years who underwent endoscopic skull base surgery were participated in this study. Main Outcome Measures Patient demographics, pathology, reconstructive technique, intraoperative findings, intraoperative, and postoperative surgical complications were measured through this study. Results Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients aged 0 to 18 years met inclusion criteria for final analysis. Seven of the 12 studies discussed a single pathology. The most common pathology was a skull base defect causing cerebrospinal fluid (CSF) leak. The majority of skull base repairs were made with free tissue grafts. The most common postoperative complication was CSF leak ( n = 40). Twelve cases of meningitis occurred postoperatively with two of these episodes resulting in death. Conclusion Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

Keywords: endoscopic skull base surgery; outcomes; pediatric; skull base surgery.