Editorial: Skull base surgery

Abstract

In their paper in this issue, Hayhurst et al.1 report a single-institutional retrospective review over a 10-year period of 23 children with tumors of varying types who required skull base surgical approaches. The children ranged from 1 to 15 years of age. Fifty-seven percent of the children had benign histology, and half underwent complete resection of their tumors. At a mean follow-up of 60 months, the authors reported 1 perioperative death and 2 children who died of disease progression. Progression-free survival was 95% at 1 year and 68% at 5 years. Fifty-nine percent of patients required adjuvant therapy. Interestingly, 1 child underwent subtotal resection of a clival chordoma, but did not receive adjuvant therapy and has not shown tumor progression during follow-up. Two children suffered the complication of postoperative CSF leakage followed by meningitis, postmeningitic hydrocephalus, and shunt placement, and are cognitively impaired as a result. This result emphasizes the fact that CSF leakage, the most common complication of skull base surgery in children, can have serious long-term consequences. Alternatively, the authors report that 85% of the children remain in mainstream schooling without the need for special educational assistance. This review, as have others, reminds us that recent technical advances—such as image guidance, better neurophysiological monitoring, endoscope-assisted minimally invasive surgery, and intraoperative imaging—can further reduce morbidity from these operations. The development of dedicated pediatric skull base surgical teams further improves the cosmetic and functional outcomes of these children by avoiding injury to rudimentary teeth, minimizing injury to the developing facial skeleton, and limiting radiation doses to growing basicranial structures. The last 3 columns of Table 2 demonstrate the relative insensitivity of the Late Effects Severity Score (LESS) in rating the functional outcomes of these children. (http://thejns.org/doi/abs/10.3171/2012.10.PEDS12479)