2026 Poster Presentations
P183: USE OF A MULTIPORTAL ENDOSCOPIC TRANSNASAL AND TRANSORBITAL APPROACH FOR PEDIATRIC SKULL BASE NEOPLASMS: CASE SERIES AND LITERATURE REVIEW.
Adriel Barrios-Anderson, MD1; Zirun Zhao, MD1; Christopher Seward, MD1; Tyler Lazaro, MD1; Kate Fagley1; Samuel Emerson, MD, PhD1; Seth Friedman, PhD2; Manuel Ferreira, MD, PhD1; Richard Ellenbogen, MD1; Samuel Browd, MD, PhD1; Hannah Goldstein, MD1; Matthew Recker, MD1; Amy Lee, MD1; Kris Moe, MD3; Randall Bly, MD3; Jacob Ruzevick, MD1; 1Department of Neurological Surgery, University of Washington/Seattle Children's Hospital, Seattle, Washington; 2Seattle Children's Hospital, Department of Radiology, Seattle, Washington; 3Department of Otolaryngology-Head and Neck Surgery, University of Washington/Seattle Children's Hospital, Seattle, Washington
Background: Lesions of the pediatric skull base can involve multiple sinonasal and intracranial compartments, posing unique surgical challenges due to limited pneumatization, immature bony structures, and the need to balance oncologic control with functional preservation and cosmetic outcomes. Combining endoscopic endonasal and transorbital corridors allows for multiple visual vectors and instrument triangulation without the need for open transcranial or transfacial approaches. Use of this strategy has not been widely reported in the pediatric literature.
Objective: To present a pediatric case series of multiportal endoscopic transnasal and transorbital approaches for skull base lesions, highlighting technical nuances, outcomes, and a review of the limited pediatric literature.
Methods: An IRB-approved single institutional retrospective cohort study of pediatric patients (<18 years) undergoing a combined endoscopic endonasal and transorbital neuroendoscopic approach between 2022 and 2025 was performed. Patient demographics, imaging characteristics, surgical technique, and perioperative outcomes were reviewed from the electronic medical record. All cases were planned using high-resolution CT/MRI and Mimics software for trajectory simulation. A targeted literature review of pediatric cases describing transorbital or combined endonasal–transorbital endoscopic approaches was also performed.
Results: Two patients (ages 10 and 14 years; one male, one female) underwent combined multiportal endoscopic surgery for anterior cranial fossa ossifying fibromas with orbital and frontal sinus involvement. Gross-total resection was achieved in both cases. One patient developed a weeping intraoperative CSF leak from basal frontal dura, repaired with a free mucosal graft and managed with temporary lumbar drainage. Both patients experienced transient ipsilateral diplopia, which resolved completely within weeks. There were no cases of postoperative CSF leak, vision loss, vascular injury, cranial neuropathy, or recurrence over a median follow-up of 14 months.
Conclusions: A multiportal endoscopic endonasal and transorbital neuroendoscopic approach can safely be utilized for complex lesions of the pediatric skull base. Multiportal access affords improved visualization, expanded working angles, and bimanual instrumentation compared to single-corridor approaches affording complete lesional resection in a single setting in appropriately selected patients. While transient vision changes occur, all resolved to baseline visual function.
Figure 1: (A and B) Representative preoperative CT showing a frontal sinus and orbital skull base mass. (C and D) Representative postoperative CT showing complete resection of respected lesions via a multiportal endoscopic endonasal and transorbital neuroendoscopic approach
