CRANIOFACIAL ACCESS IN CHILDREN

We have used craniofacial access in 20 children (age range 3/12-14 yea rs) for complex skull base/intracranial pathology over the past 5 year s. The majority of the patients had a tumour - 7 of the skull base, 5 extensive suprasellar lesions and 3 acoustic neuromas; 4 had an aneury sm or AVM and in 1 there was a congenital problem. This extended appli cation of established adult techniques in a paediatric practice emphas ises the fundamental point that the quintessence of good surgical prac tice is the construction of an operation for the individual patient's pathology. We therefore used trans-zygomatic, orbital, transoral, tran smandibular, petrous, transcondylar, translabyrinthine and transbasal access techniques. Good function and cosmesis with minimal complicatio ns were achieved. We have not observed complications with craniofacial growth and the majority of patients were able to return to normal sch ool. The range of approaches used emphasise the importance of a multid isciplinary team with both paediatric and neurosurgical expertise, esp ecially with complex Vascular and skull base pathology, in dealing wit h these difficult problems. The case for specialist referral merits so me discussion within the representative bodies of paediatric neurosurg eons.