gms | German Medical Science

Objective: Anterior skull base tumors are rare in the pediatric population. Surgical removal may result in long-term complications, especially due to the delicate anatomic structures in this particular location. This study aims to evaluate perioperative complications and clinical outcome over a long time period.

Methods: 61 patients diagnosed with anterior skull base tumors (30 girls and 31 boys) under 18 years of age (mean 9.95, SD 4.84, range 0.08–7.8 years) were treated at our institution from 2000 to 2010. Medical records were analyzed retrospectively for epidemiological data, histology, treatment modality including surgical approach, perioperative complications, as well as short- and long-term clinical outcome. Postoperative histologic diagnoses included 20 craniopharyngiomas, 14 pilocytic astrocytomas, 8 pituitary adenomas and 19 rare tumor entities. Surgical approaches included 43 frontal craniotomies and 15 transsphenoidal approaches.

Results: Of 61 patients 58 are still alive (OS 95%) – three patients died between the ages of 6 months and 8 years, all due to progression of malignant rhabdoid tumors. Postoperative neurological complications included transient postoperative seizures (11, 18,3%), transient hemiparesis (4, 6.7%), permanent seizures (4, 6,7%), persistent hemiparesis (2, 3.4%), and 18 patients with cranial nerve lesions (6 transient 10% and 12 persistent 20%). CSF leaks were seen and treated in 10 patients (16.4%). 35 patients had no visual changes (58.3 %). Improvement of visual acuity was seen in 6 patients (10%) and reduction of vision in 15 children (25%). Total loss of vision in one eye was seen in 4 cases (6.7%). New onset obesity (weight >97. percentile) was highly associated with craniopharyngiomas (8, 40%) compared to other histologies (P=0.023). Other statistically significant associations were observed: Strabismus divergens and pilocytic astrocytoma (P=0.002), scotomas and craniopharyngiomas (P=0.045), postoperative short-term epilepsy in frontal craniotomies compared to transsphenoidal approaches (P=0.037), deterioration in school performance was associated with multiple surgeries (P=0.012) and all post-operative cases of pubertas praecox had a new onset of obesity (P=0.037).

Conclusions: Overall survival after anterior skull base surgery in the pediatric population is favorable, if the diagnosis is not malignant rhabdoid tumor. However, surgically aggressive treatment is associated with various significant neurological, visual and endocrinological long-term effects.