Tsai Eve C, Santoreneos Stephen, Rutka James T
Division of Neurosurgery, The University of Toronto, Ontario, Canada.
Neurosurg Focus. 2002 May 15;12(5):e1. doi: 10.3171/foc.2002.12.5.2.
Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.
尽管已有许多关于成人颅底肿瘤治疗策略的报道，但关于儿童患者此类治疗的报道相对较少。儿童颅底肿瘤因其独特的病理构成、颅骨和脑发育成熟的限制以及患儿体型较小，带来了治疗挑战。在这篇综述中，作者研究了发生在前颅底、中颅底和后颅底的儿童颅底病变，重点关注诸如脑膨出、骨纤维发育不良、嗅神经母细胞瘤、颅咽管瘤、青少年鼻咽血管纤维瘤、胆脂瘤、脊索瘤、软骨肉瘤和尤因肉瘤等独特的儿童肿瘤。他们回顾了包括放疗和化疗在内的治疗策略，以及手术方法，重点介绍了适用于儿童的手术改良方法和相关并发症。将研究放疗、化疗和手术在儿童患者中的优势和局限性的证据。凭借对颅底解剖结构的实用知识以及对发育中的颅面骨骼的特殊考虑，神经外科医生能够以可接受的发病率和死亡率治疗儿童颅底病变。该人群的治疗效果可能优于成人，部分原因在于儿童颅底病变常具有良性组织病理学特征，以及发育中的神经系统具有可塑性。
