Lateral Skull Base Approaches in Pediatric Skull Base Surgery

Abstract

Lateral skull base pathology is rare in children. Awareness of the potential for lateral skull base lesions in children is imperative for timely identification and appropriate management. Some of the common presentations and pathologies shall be presented, as well as a variety of approaches that may be utilized to access the lateral skull base in the pediatric patient. Although the lateral skull base approaches utilized in adults may also be considered for management of pediatric lesions, some special considerations given the small developing anatomy need to be kept in mind.

Keywords: cholesteatoma; endoscopic; lateral skull base; pediatric; pediatric skull base; petrous bone; rhabdomyosarcoma; skull base; surgical approach; temporal bone.

Fig. 1

Comparison of infant temporal bone (left) and adult temporal bone (right). In infants, there is a lack of an inferior portion of the bony ear canal and there is no mastoid process. The mastoid process begins to appear at around 1 year of age. The mastoid process develops relatively well by 3 years of age. Lack of the mastoid process in infants can result in the stylomastoid foramen to be exposed and the facial nerve tends to be very superficial and is more susceptible to injury.

Fig. 2

Fisch type A, B, and C surgical approaches.