2026 Poster Presentations
P178: PEDIATRIC MIDDLE FOSSA CRANIOTOMY: INSTITUTIONAL EXPERIENCE AND SURGICAL OUTCOMES
Eric Cunningham, BA1; Alireza Zonnour, MD1; Krish Suresh, MD1; Michael Brandel, MD2; Michael Levy, MD, PhD2; Marc Schwartz, MD2; Rick A Friedman, MD, PhD1; 1University of California, San Diego Department of Otolaryngology - Head & Neck Surgery; 2University of California, San Diego Department of Neurological Surgery
Introduction: Middle fossa craniotomy (MFC) with exposure of the internal auditory canal and/or petrous apex (anterior petrosectomy) is an uncommon operation in the pediatric population. We report our institution’s experience and surgical outcomes with pediatric MFC.
Methods: We conducted a retrospective review for MFC with exposure of the internal auditory canal and/or petrous apex performed at our institution from 2018-2024 in patients aged 18 and under. Data collected included demographics, office visits, surgery and inpatient stay, audiometrics, and imaging.
Results: Sixteen patients met our inclusion criteria. Median age was 12 years (range 1-18), 10 (63%) were male. The pathology treated was: 9 (56%) VS, of which 7 were neurofibromatosis 2 (NF2); and 1 (6%) each of grade I meningioma, clear cell meningioma, epidermoid cyst, cavernous malformation, atypical teratoid rhabdoid tumor, anaplastic ependymoma, prepontine abscess. On preoperative MRI, median tumor size was 12.5 mm (range 3-63). Gross total resection was achieved in 11 (69%) cases, near total in 1 (6%), and subtotal in 4 (25%). There was 1 (6%) case of CSF leak. Median length of stay was 3 days. Sixth nerve palsy was sustained in 3 (19%) cases. Facial nerve outcomes were favorable: of 11 patients with preoperative House-Brackmann (HB) I, 10 (91%) maintained HB1 postoperatively. For VS, hearing outcomes were evaluated: Preoperatively, all patients had class A hearing. At first postoperative follow-up (median 8 days), 5 (56%) maintained class A hearing and 4 (44%) were class D. At latest follow-up (median 678 days), of the 5 patients with preserved hearing, 4 maintained class A hearing, and the other one progressed to class B. On follow-up MRI (median 172 days), 7 (50%) had no evidence of disease, 1 (7%) had linear enhancement, and 6 (43%) had nodular enhancement. Of the 6 with nodular enhancement, 5 had NF2.
Conclusions: Pediatric MFC can be used to approach a variety of intracranial pathologies. VS in NF2 is the most common indication and has favorable facial nerve outcomes and hearing preservation rates similar to those in adult NF2.