PEDIATRIC NEUROTOLOGIC SKULL BASE SURGERY

The objectives of neurotologic skull base surgery are complete resecti on of the lesion and high-grade function following surgery. There is a perception that these goals are more difficult to achieve in children than in adults. Skull base disease in children and adolescents is rar e, Of the 292 skull base tumors treated from 1970 to 1995 by The Otolo gy Group in Nashville, 15 were in patients 21 years of age or younger, with only 5 patients under 10 years old. In this retrospective study, the authors review these 15 cases and compare them to their adult ser ies. The pathology encountered in the 15 young patients with skull bas e tumors included 8 glomus lesions and 4 schwannomas. In these patient s, 13 tumors occurred sporadically, and 2 tumors were related to neuro fibromatosis type 2, Advanced-stage disease and malignancy were preval ent in this younger patient group. All patients underwent excision of their skull base tumor, with one procedure considered a subtotal resec tion. As compared with an adult glomus tumor series, postoperative cra nial nerve function and complication rates were generally worse in the young glomus patients. However, postoperative function and complicati ons were consistent with the extensive procedures required for the tre atment of advanced disease, Despite the advances that have been made i n imaging and treatment modalities, this study illustrates the need fo r more timely diagnosis in younger patients with skull base tumors.