Greuter Ladina, Hallenberger Tim, Guzman Raphael, Soleman Jehuda
Department of Neurosurgery, University Hospital of Basel, 4053 Basel, Switzerland.
Department of Pediatric Neurosurgery, University Children's Hospital Basel, 4056 Basel, Switzerland.
Children (Basel). 2023 Jan 26;10(2):216. doi: 10.3390/children10020216.
Pediatric skull base lesions occur rarely and are of various etiologies. Traditionally, open craniotomy has been the treatment of choice; however, nowadays, endoscopic approaches are increasingly applied. In this retrospective case series, we describe our experience in treating pediatric skull base lesions and provide a systematic overview of the literature on the treatment and outcome of pediatric skull base lesions.
We conducted a retrospective data collection of all pediatric patients (<18 years) treated for a skull base lesion at the Division of Pediatric Neurosurgery, University Children's Hospital Basel, Switzerland, between 2015 and 2021. Descriptive statistics and a systematic review of the available literature were additionally conducted.
We included 17 patients with a mean age of 8.92 (±5.76) years and nine males (52.9%). The most common entity was sellar pathologies (n = 8 47.1%), with craniopharyngioma being the most common pathology (n = 4, 23.5%). Endoscopic approaches, either endonasal transsphenoidal or transventricular, were used in nine (52.9%) cases. Six patients (35.3%) suffered from transient postoperative complications, while in none of the patients these were permanent. Of the nine (52.9%) patients with preoperative deficits, two (11.8%) showed complete recovery and one (5.9%) partial recovery after surgery. After screening 363 articles, we included 16 studies with a total of 807 patients for the systematic review. The most common pathology reported in the literature confirmed our finding of craniopharyngioma (n = 142, 18.0%). The mean PFS amongst all the studies included was 37.73 (95% CI [36.2, 39.2]) months, and the overall weighted complication rate was 40% (95% CI [0.28 to 0.53] with a permanent complication rate of 15% (95% CI [0.08 to 0.27]. Only one study reported an overall survival of their cohort of 68% at five years.
This study highlights the rarity and heterogeneity of skull base lesions in the pediatric population. While these pathologies are often benign, achieving GTR is challenging due to the deep localization of the lesions and eloquent adjacent structures, leading to high complication rates. Therefore, skull base lesions in children require an experienced multidisciplinary team to provide optimal care.
儿童颅底病变很少见，病因多样。传统上，开颅手术一直是首选治疗方法；然而，如今内镜手术方法的应用越来越多。在这个回顾性病例系列中，我们描述了我们治疗儿童颅底病变的经验，并对儿童颅底病变的治疗和结果的文献进行了系统综述。
我们对2015年至2021年期间在瑞士巴塞尔大学儿童医院小儿神经外科接受颅底病变治疗的所有儿科患者（<18岁）进行了回顾性数据收集。此外，还进行了描述性统计和对现有文献的系统综述。
我们纳入了17例患者，平均年龄为8.92（±5.76）岁，男性9例（52.9%）。最常见的病变是鞍区病变（n = 8，47.1%），颅咽管瘤是最常见的病理类型（n = 4，23.5%）。9例（52.9%）患者采用了内镜手术方法，包括经鼻蝶窦或经脑室途径。6例患者（35.3%）出现了术后短暂并发症，但无一例为永久性并发症。在9例（52.9%）术前有功能缺损的患者中，2例（11.8%）术后完全恢复，1例（5.9%）部分恢复。在筛选了363篇文章后，我们纳入了16项研究，共807例患者进行系统综述。文献中报道的最常见病理类型证实了我们关于颅咽管瘤的发现（n = 142，18.0%）。纳入的所有研究的平均无进展生存期为37.73（95%CI[36.2，39.2]）个月，总体加权并发症发生率为40%（95%CI[0.28至]0.53），永久性并发症发生率为15%（95%CI[0.08至0.27]）。只有一项研究报告其队列的五年总生存率为68%。
本研究强调了儿童颅底病变的罕见性和异质性。虽然这些病变通常是良性的，但由于病变位置深且邻近结构功能重要，实现肿瘤全切除具有挑战性，导致并发症发生率高。因此，儿童颅底病变需要一个经验丰富的多学科团队来提供最佳治疗。
