Application of skull base techniques to paediatric neurosurgery

Abstract

Objective: To analyze the pathology and surgical outcomes of skull base approaches in a paediatric population. Method: Retrospective case review in Queen Mary Hospital and The University of Hong Kong-Shenzhen Hospital during in 2017-2018. Charts of paediatric patients who underwent skull base procedures for various pathologies including vascular or brain tumour was included. A review of literature was performed to compare any difference or difficulty encountered to operate in a developing rather than a developed skull bone. Result: A total of 4 paediatric patients received skull base surgeries during that period. Two of them were tumours near the medial cerebellopontine angle and they had lateral skull base approach for tumour excision. The other two were dural arterio-venous fistula located in the medial pre-pontine and upper cervico-medullary region, they had lateral skull base and far lateral approach respectively for clipping of the fistula. All of them were below 10 years old, none of them has permanent added neurological deficit nor CSF leakage, they all discharged home in a week with good functional outcome. It is also evident that for at least 10 years after birth, the skull base of a child is incompletely developed. It is not surprising then that adult surgical approaches to the cranial base require modification when implemented in a child. These modifications are dependent on the anatomic maturity of the individual patient. Conclusion: Skull base surgery does have a role in paediatric practice. Although such surgery is high risk, the outcomes are good in our patients without added neurological deficit. Understanding of the growth of the paediatric skull base would make the implementation of adult skull base approach safer.