Application of skull base techniques to pediatric neurosurgery

Techniques for skull base surgery have become well established over the las t 10 years. Most of these techniques are used in adult patients for skull b ase tumors and neurovascular diseases. There are very few large series of p ediatric patients in whom skull base approaches have been used, because of the rarity of these conditions. The authors would like to present a relativ ely large series of 26 pediatric patients who underwent skull base approach es for tumor resection. These tumors involved the anterior cranial base in 5 patients, the medial cranial skull base in 4 patients, and the posterior cranial base in 12 cases. Five patients had tumors that involved two or mor e fossae. The overall complication rate was 57%, which included temporary c ranial nerve palsies, CSF leak and infection. Patients with permanent compl ications were 8 in number (37%). There was 1 postoperative death from pneum onia approximately 6 weeks after surgery. Complete tumor removal was achiev ed in 24 of the 26 patients. Skull base tumors in children are often extens ive and present significant surgical challenges. Although complete tumor ex tirpation is the goal in most pediatric patients, this is often achieved on ly with some morbidity. This paper demonstrates the effectiveness of skull base approaches for these tumors and underscores the high stakes involved.