Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan-Mar;16(1):35-43.
doi: 10.4103/jpn.JPN_56_20. Epub 2021 Jun 25.

Pediatric Skull Base Tumors: A Management Challenge

Matheus F M Ballestero  1   2 , Stephanie N F de Souza  2 , Romilto C Pacheco Neto  2 , Guilherme G P Gondim  2 , Elvis T Valera  3 , Maristella B F Dos Reis  3 , Benedicto O Colli  2 , Ricardo S de Oliveira  2
Affiliations

Pediatric Skull Base Tumors: A Management Challenge

Matheus F M Ballestero et al. J Pediatr Neurosci. 2021 Jan-Mar.

Abstract

Context: Skull base tumors are varied in children and are particularly challenging to pediatric neurosurgeons, with few papers in the literature describing the evolution, complications, and outcome. The authors evaluated long-term outcomes in children submitted to skull base tumor surgery and performed a literature review.

Aims: The aim of this study was to analyze surgical results, complications, and outcomes, on comparison with previous publications.

Materials and methods: A retrospective analysis of children undergoing surgery at a single institution between 2000 and 2018 for lesions of the cranial base was carried out. In addition, a literature review was carried out describing a total of 115 children operated on for skull base tumors.

Statistical analysis: Chi-squared and Fisher's exact tests were performed to compare the distribution of categorical variables and a nonparametric Mann-Whitney U test was used to perform intergroup comparisons of continuous variables.

Results: Seventeen children ranging in age from 8 months to 17 years (mean, 10.9 years) underwent skull base approaches. Tumor types included schwannoma, meningioma, chondroid chordoma, mature teratoma, epidermoid cyst, hemangiopericytoma, rhabdomyosarcoma, myofibroblastic inflammatory tumor, fibromyxoid sarcoma, Crooke's cell adenoma, ossifying fibroma, osteoblastoma, nasopharyngeal angiofibroma and Ewing's sarcoma. Gross total resection was achieved in 6 patients (35.3%), 12 patients (70.6%) had benign histology, and 5 patients (29.4%) had a malignant tumor. Transient postoperative cerebrospinal fluid leak affected only one patient. Thirteen children (76.4%) had a residual neurological deficit at last follow-up evaluation. Three (17.6%) surviving patients received adjuvant therapy. The rate of recurrence or lesion progression was 17.6%.

Conclusions: Skull base tumors in children present a therapeutic challenge because of their unique pathological composition and can lead to considerable morbidity and mortality in pediatric age.

Keywords: Children; skull base; surgery; tumor.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Skull base tumors in pediatric cases. Axial T1-weighted images after gadolinium showing a heterogeneous localization of the lesion as well as histology, tumors is highlighted with a white arrow. (A) Petroclival undifferentiated neuroendocrine carcinoma. (B) Cerebellopontine angle epidermoid cyst. (C) Jugular foramen meningioma. (D) Cavernous sinus Crooke’s cell adenoma. (E) Petrous temporal bone osteoblastoma. (F) Ethmoid bone ossifying fibroma. (G) Sphenoid bone fibromyxoid sarcoma. (H) Olfactory groove Ewing’s sarcoma. (I) Geniculate ganglion Schwannoma (VII nerve). (J) Bilateral cerebellopontine angle Schwannoma (VIII nerve)
Figure 2
Figure 2
Case no. 13. First surgery preoperative MR scan showing pituitary lesion extending to right cavernous sinus (white arrow). (A) Coronal T2-weighted. (B) Sagittal T1-weighted after contrast injection
Figure 3
Figure 3
Case no. 13. Second surgery preoperative MR scan showing lesion extending to right cavernous sinus and posterior fossa (white arrow). (A) Axial T1-weighted after contrast injection. (B) Coronal T1-weighted after contrast injection
Figure 4
Figure 4
Possible surgical approaches to access skull base tumors
See this image and copyright information in PMC

References

    1. Donald PJ. Surgery of the skull base. Philadelphia, PA: Lippincott-Raven; 1998.
    1. Hayhurst C, Williams D, Yousaf J, Richardson D, Pizer B, Mallucci C. Skull base surgery for tumors in children: long-term clinical and functional outcome. J Neurosurg Pediatr. 2013;11:496–503. - PubMed
    1. Hanbali F, Tabrizi P, Lang FF, DeMonte F. Tumors of the skull base in children and adolescents. J Neurosurg. 2004;100:169–78. - PubMed
    1. Rosemberg S, Fujiwara D. Epidemiology of pediatric tumors of the nervous system according to the WHO 2000 classification: a report of 1,195 cases from a single institution. Childs Nerv Syst. 2005;21:940–4. - PubMed
    1. Teo C, Dornhoffer J, Hanna E, Bower C. Application of skull base techniques to pediatric neurosurgery. Childs Nerv Syst. 1999;15:103–9. - PubMed