Introduction: Endoscopic endonasal surgery (EES) has been slower to gain popularity in early childhood due to anatomical challenges. We sought to describe the safety and efficacy of EES in early childhood. Methods: All patients younger than 7 years who underwent EES at a large Cranial Base Center from 2002 to 2019 were reviewed as a retrospective cohort study. Results: Thirty-six patients underwent EES before the age of 7 years. Four patients had two-stage EES. Two patients required combined transcranial and endonasal approaches. The mean age at the time of initial surgery was 4 years (range: 1–6). Twenty patients were male, and 16 were female. Of 21 tumors intended for resection, 11 patients had gross total resections, and 10 had near total (>95% tumor removed) resections. Nine patients (43%) had recurrences, of which 6 were craniopharyngiomas (p = 0.01). There was no difference in recurrence rates based on the degree of resection (p = 0.67). Three cerebrospinal fluid (CSF) leaks occurred following primary EES (8%). Following an increase in nasoseptal flap usage (31–52%) and CSF diversion (15–39%) in 2008, there was only one CSF leak out of 23 patients (4 vs. 15%; p = 0.54). Postoperatively, 1 patient developed a permanent new cranial neuropathy, and 1 patient developed a permanent visual field cut. Six patients developed permanent postoperative panhypopituitarism, of which all were craniopharyngiomas (p < 0.001). The mean follow-up was 64 months. Conclusions: Early childhood EES is both safe and technically feasible for a variety of pathologies.

1.
Hadad
G
,
Bassagasteguy
L
,
Carrau
RL
,
Mataza
JC
,
Kassam
A
,
Snyderman
CH
,
A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap
.
Laryngoscope
.
2006 Oct
;
116
(
10
):
1882
6
.
2.
Kassam
AB
,
Thomas
A
,
Carrau
RL
,
Snyderman
CH
,
Vescan
A
,
Prevedello
D
,
Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap
.
Neurosurgery
.
2008 Jul
;
63
(
1 Suppl 1
):
ONS44
3
; discussion ONS52–3. .
3.
Rastatter
JC
,
Snyderman
CH
,
Gardner
PA
,
Alden
TD
,
Tyler-Kabara
E
.
Endoscopic endonasal surgery for sinonasal and skull base lesions in the pediatric population
.
Otolaryngol Clin North Am
.
2015 Feb
;
48
(
1
):
79
99
. .
4.
Jeswani
S
,
Nuño
M
,
Wu
A
,
Bonert
V
,
Carmichael
JD
,
Black
KL
,
Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study
.
J Neurosurg
.
2016 Mar
;
124
(
3
):
627
38
. .
5.
Abunimer
AM
,
Abou-Al-Shaar
H
,
Azab
MA
,
Karsy
M
,
Guan
J
,
Kestle
JR
,
Transsphenoidal approaches for microsurgical resection of pituitary adenomas in pediatric patients
.
World Neurosurg
.
2019 Mar
;
123
:
e186
93
.
6.
Chen
W
,
Gardner
PA
,
Branstetter
BF
,
Liu
SD
,
Chang
YF
,
Snyderman
CH
,
Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth
.
J Neurosurg Pediatr
.
2019 Jan 11
;
23
:
523
30
. .
7.
Hamid
O
,
El Fiky
L
,
Hassan
O
,
Kotb
A
,
El Fiky
S
.
Anatomic variations of the sphenoid sinus and their impact on trans-sphenoid pituitary surgery
.
Skull Base
.
2008 Jan
;
18
(
1
):
9
15
.
8.
Tatreau
JR
,
Patel
MR
,
Shah
RN
,
McKinney
KA
,
Wheless
SA
,
Senior
BA
,
Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients
.
Laryngoscope
.
2010 Sep
;
120
(
9
):
1730
7
.
9.
Banu
MA
,
Guerrero-Maldonado
A
,
McCrea
HJ
,
Garcia-Navarro
V
,
Souweidane
MM
,
Anand
VK
,
Impact of skull base development on endonasal endoscopic surgical corridors
.
J Neurosurg Pediatr
.
2014 Feb
;
13
(
2
):
155
69
.
10.
Shah
RN
,
Surowitz
JB
,
Patel
MR
,
Huang
BY
,
Snyderman
CH
,
Carrau
RL
,
Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects
.
Laryngoscope
.
2009 Jun
;
119
(
6
):
1067
75
.
11.
Ghosh
A
,
Hatten
K
,
Learned
KO
,
Rizzi
MD
,
Lee
JY
,
Storm
PB
,
Pediatric nasoseptal flap reconstruction for suprasellar approaches
.
Laryngoscope
.
2015 Nov
;
125
(
11
):
2451
6
.
12.
Waitzman
AA
,
Posnick
JC
,
Armstrong
DC
,
Pron
GE
.
Craniofacial skeletal measurements based on computed tomography: part II. Normal values and growth trends
.
Cleft Palate Craniofac J
.
1992 Mar
;
29
(
2
):
118
28
.
13.
Pinheiro-Neto
CD
,
Prevedello
DM
,
Carrau
RL
,
Snyderman
CH
,
Mintz
A
,
Gardner
P
,
Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study
.
Laryngoscope
.
2007 Sep
;
117
(
9
):
1560
9
.
14.
Nation
J
,
Schupper
AJ
,
Deconde
A
,
Levy
M
.
Pediatric endoscopic endonasal approaches for skull base lesions in the very young: is it safe and effective?
J Neurol Surg B Skull Base
.
2018 Dec
;
79
(
6
):
574
9
. .
15.
London
NR
,
Rangel
GG
,
Onwuka
A
,
Carrau
RL
,
Prevedello
DM
,
Leonard
JA
,
Reconstruction of pediatric skull base defects: a retrospective analysis emphasizing the very young
.
Int J Pediatr Otorhinolaryngol
.
2020 Feb
;
133
:
109962
.
16.
Koutourousiou
M
,
Gardner
PA
,
Fernandez-Miranda
JC
,
Tyler-Kabara
EC
,
Wang
EW
,
Snyderman
CH
.
Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients
.
J Neurosurg
.
2013 Nov
;
119
(
5
):
1194
207
.
17.
Lin
LL
,
El Naqa
I
,
Leonard
JR
,
Park
TS
,
Hollander
AS
,
Michalski
JM
,
Long-term outcome in children treated for craniopharyngioma with and without radiotherapy
.
J Neurosurg Pediatr
.
2008 Feb
;
1
(
2
):
126
30
.
18.
Schoenfeld
A
,
Pekmezci
M
,
Barnes
MJ
,
Tihan
T
,
Gupta
N
,
Lamborn
KR
,
The superiority of conservative resection and adjuvant radiation for craniopharyngiomas
.
J Neurooncol
.
2012 May
;
108
(
1
):
133
9
.
19.
Zeinalizadeh
M
,
Sadrehosseini
SM
,
Habibi
Z
,
Nejat
F
,
Silva
HB
,
Singh
H
.
Endonasal management of pediatric congenital transsphenoidal encephaloceles: nuances of a modified reconstruction technique. Technical note and report of 3 cases
.
J Neurosurg Pediatr
.
2017 Mar
;
19
(
3
):
312
8
. .
20.
Stapleton
AL
,
Tyler-Kabara
EC
,
Gardner
PA
,
Snyderman
CH
,
Wang
EW
.
Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery
.
Int J Pediatr Otorhinolaryngol
.
2017 Feb
;
93
:
163
6
. .
21.
Zwagerman
NT
,
Wang
EW
,
Shin
SS
,
Chang
YF
,
Fernandez-Miranda
JC
,
Snyderman
CH
,
Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial
.
J Neurosurg
.
2018
;
10
:
1
7
.
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