2026 Poster Presentations
P177: CONTEMPORARY MULTI-CORRIDOR MANAGEMENT OF PAEDIATRIC SKULL BASE LESIONS: LESSONS FROM A 5-YEAR EXPERIENCE AND THE CASE FOR SPECIALIST EXPERTISE
Cristina Cernei, MD1; Evangelos Drosos, MD1; Mahmoud Asad, MD1; Camille Milton, MD2; Phillip Clamp, MD, FRCS3; William Singleton, MD, PhD, FRCS4; Greg Fellows, MD, FRCS4; Samantha Hunt, MD, FRCS5; Rebecca Ford, MD, FRCS5; Warren Bennett, MD, FRCS3; Richard Edwards, MD, FRCS4; Kumar Abhinav, MD, FRCS1; 1Bristol Institute of Clinical Neuroscience, Department of Neurosurgery, Southmead Hospital, Bristol, UK; 2University of Tennessee, Semmes Murphey Clinic, Department of Neurosurgery; 3Bristol Institute of Clinical Neuroscience, Department of ENT, Bristol Children's Hospital, Bristol, UK; 4Bristol Institute of Clinical Neuroscience, Department of Neurosurgery, Bristol Children's Hospital, Bristol, UK; 5Bristol Eye Hospital, Department of Ophthalmology, Bristol, UK
Objective: To describe the use of contemporary multi-corridor skull base approaches in the paediatric population over a 5-year period.
Design Retrospective chart review.
Subjects Paediatric patients undergoing complex skull base approaches between 2019 and 2025 performed by the senior author (KAA) with a multidisciplinary team.
Method Clinical, radiological, and operative records were reviewed. Data included patient age, pathology, surgical approach, extent of resection, visual and pituitary outcomes, recurrence status, and complications.
Results A total of 31 operations in 25 patients (age range: 2–17 years, mean: 9 years) were performed, of which 21/31 (67.7%) were EEA. Among these, 20/21 (95.2%) were pure EEA and 1/21 (4.8%) combined with an orbital corridor for a large midline skull base ossifying fibroma, achieving effective exposure and clearance without complications.
Craniopharyngiomas accounted for 16/31 procedures (51.6%) in 13 patients. Of these, 11/16 (68.8%) were performed via EEA and 5/16 (31.2%) via open approaches. One patient underwent EEA at presentation and again for recurrence; two had both open and EEA at different stages; and three were managed exclusively by open approaches. Among the cohort, 5/13 (4 EEA, 1 open) were primary presentations with no recurrence to date, while 8/13 (2 open, 2 sequential open/EEA, 6 EEA) represented recurrent disease. The recurrent group had been initially managed either with surgery alone or surgery plus SRS at an earlier time point, and subsequently presented for further treatment; 4/8 achieved disease control following a single EEA with the senior author, while 4/8 required two further interventions.
Beyond craniopharyngiomas, EEA was utilised in 7/21 procedures for other pathologies: spontaneous CSF leak (1), odontoidectomy post-radiotherapy (1), Cushing’s disease (1), acromegaly (1), nasopharyngeal rhabdosarcoma (1), psammomatoid ossifying fibroma (1), and a third ventricular germ cell tumour (1). Postoperative CSF leak occurred in 3 cases (2 craniopharyngiomas, 1 odontoidectomy), both craniopharyngiomas in the first year of this series.
Orbital approaches (n=4) were used for lesions not readily addressed endonasally or by open routes, including recurrent suprasellar epidermoid, laterally placed recurrent craniopharyngioma, Meckel’s cave meningocele, and spontaneous complex CSF leak. Two cases had transient ocular morbidity, both resolving without long-term deficit.
Extended pterional approaches (n=6) were performed for recurrent craniopharyngiomas (4), cavernous sinus meningioma biopsy (1), and apical petrosectomy for Langerhans’ cell histiocytosis (1). One two-year-old with craniopharyngioma developed vasospasm and watershed infarct but recovered near-normally over 6 months.
Conclusion EEA remains the predominant corridor for paediatric skull base pathologies, particularly craniopharyngioma resulting in excellent outcomes. Open corridors including transorbital routes add to this armamentarium and provide access to the multiple skull base zones including the suprasellar compartment, cavernous sinus, middle fossa and the Meckel’s cave.. Operative learning curve should be respected.These results highlight the feasibility of applying contemporary skull base approachedstrategies in children when performed in dedicated centres by a specialistskull base neurosurgeon treating adult and pediatric skull base pathologies while working alongside multidisciplinary team comprising of otolaryngology, oculoplastic, and paediatric teams.