Safety and feasibility of the endoscopic endonasal approach to anterior skull base tumour resections in young children

Tumours of the anterior skull base present unique surgical challenges due to critical neurovascular proximity and developing cranial anatomy. While open transcranial approaches (TCAs) have traditionally been used for these tumors, the endoscopic endonasal approach (EEA) is preferred due to reduced morbidity and higher gross total resection (GTR) rates (1). Studies report excellent GTR rates and reconstructive outcomes with EEA in the under-18 paediatric population, with complications including cerebrospinal fluid (CSF) leak, meningitis, and stroke being relatively rare (2-5). However, limitations in anatomy, including restricted sphenoid pneumatization, narrower nasal apertures, and smaller nasoseptal flaps (NSFs), contribute to hesitancy in adopting EEA for younger patients (6,7). Minimal evidence focuses on outcomes in young pediatric patients in particular. This study evaluates outcomes of EEAs for anterior skull base pathologies in young paediatric patients.