Skull base Surgery in children
Skull base Surgery in children
Paediateric skull base surgery for tumours or tumour-like
conditions is unique because of the small size of the growing skull and the inability to withstand blood loss during surgery.Skull base in children
Fig.1.
The skull base (Fig.1) is the bony surface under the brain. There are number of structures lie below the skull base viz. nose & sinuses, eyes, ears etc. Major blood vessels taking blood to and from brain, nerves of the eye, ear and those controlling facial movement, swallowing & speech and spinal cord passes through number of natural foramina in the skull base. All these structures are cramped into a small area in children (Fig.2).
Fig.2.
What are the skull base conditions treated in children?
A variety of conditions viz. dermoid, teratoma (developmental tumour and contain keratin, cellular debris, hair, and sebum), herniation of brain (meiningoencephalocoele), craniopharyngioma and malignant tumours (more likely sarcomas) occur in paediateric skull base. Tumours and tumour-like conditions at the skull base are often close to critical areas of the brain and these nerves and blood vessels.
How is skull base surgery performed in children?
Paediatric skull base surgery is a rapidly developing field involving multiple specialties. The collaboration between otolaryngology, neurosurgery, paediatric critical care and nursing has evolved to allow for the optimal management of paediatric patients.
Skull base surgery can be done in two main ways. Although the preferred method is endoscopic, open surgery is also an option, depending on the type of growth that needs to be removed and its location:
1) Endoscopic or minimally invasive skull base surgery. This type of surgery often doesn’t require a skin incision. Surgeon passes the endoscope through the nasal cavity and sinuses and then into the skull base (Fig.3). The endoscope enables surgeon to see the tumour and the complex skull base structures, including important nerves and blood vessels. Surgeon places small tools alongside the endoscope remove remove the tumour or tumour-like condition (Fig.4 & 5) (Video). This does not interfere with the growth centres of facial bones and skull and therefore does not affect the normal growth of face and skull.
Fig.3
Fig.4
Fig.5
2) Traditional or open skull base surgery. This type of surgery may require incisions in the facial area and in the skull. Parts of bone may need to be removed so that the tumour can be reached and removed.
Surgeons use innovative surgical techniques to remove theses tumours in this complex area of children with minimal effect in the normal growth of the skull (Fig.6a&b) (Fig.7a&b). An operating microscope is often used for this type of surgery.
Fig.6a
Fig.6b
Fig.7a
Fig.7b
3) Lateral skull base surgery. The “lateral skull base” is located at the side of the skull (Fig.8). This portion of the skull base includes structures called the temporal bone (most of the ear is within this bone), infratemporal fossa, clivus, and middle and posterior fossae. Lateral skull base surgery can be used to treat conditions like encephaloceles , cholesteatomas, and malignant tumours of the ear and temporal bone (Fig.9a-e).
Therefore, operating in this area in children needs good knowledge of the complex anatomy. Experience brings out accuracy and precision.
Fig.8
Fig.9a
Fig.9b
Fig.9c
Fig.9d
Fig.9e
What steps are taken during skull base surgery in children to make it safe?
Fig.10
As mentioned earlier, skull base is a complex area packed with important structures like eye, ear etc., blood vessels, cranial nerves controlling vision, hearing, facial movement, speech and swallowing. Nothing can replace a thorough knowledge of the anatomy and experience in operating in this complex area in children. To improve the accuracy, surgeons use equipments like neuro navigation (which functions like GPS) (Fig.10) and endoscopic Doppler. Our vast experience in adult open and endoscopic skull base surgery is safely implemented in treating these conditions in children.
The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)
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The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)