Endonasal Endoscopic Skull Base Surgery in Children: Anatomical and Technical Considerations

Endoscopic endonasal approach has now become the workhorse of pituitary surgery and its utility has rapidly expanded to midline skull base lesions in adults. Though it has been gaining ground in paediatric practice over the last few years, it has not received wide acceptance. Children are not simply small-sized adults—there are significant differences in anatomy, physiology as well as pathology that necessitate a modification for the endoscopic endonasal approach. This chapter presents a review of development of the skull base and radiological studies of its growth during childhood and technical considerations of surgery. The scope and limitations of this approach are further discussed with attendant complications with a few illustrative cases. We hope to be able to better define the strategy for approaching skull base lesions in children by case selection, surgical technique, and understanding the factors governing the outcome of endoscopic endonasal surgery in the paediatric age group.