{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:22:15Z","timestamp":1787026935798,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T00:00:00Z","timestamp":1653609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advances in surgical techniques based on in-depth anatomical knowledge of the skull base have broadened the indications for endoscopic skull base surgery (ESS) with the advantage of wide and direct surgical exposure while minimizing invasiveness. However, the low incidence of the indicated diseases and narrow surgical corridors in children have limited the popularization of ESS. In addition, surgical complications and preventive interventions are not yet well known. Therefore, we retrospectively investigated the complications and prevention methods of ESS in children with a comprehensive review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed the medical records of pediatric patients who underwent ESS for sellar and parasellar tumors at Seoul National University Children\u2019s Hospital from July 2010 to December 2020. Visual and endocrine status, extent of resection, complications, and recurrences were investigated depending on the pathology of the tumor. In addition, a comprehensive literature review regarding the complications of pediatric ESS was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 98 patients were enrolled. The median age of the patients was 12 years, and 52 patients were male. Preoperative visual disturbance was found in 53 patients, anterior pituitary function deficit in 69, and diabetes insipidus in 32. Gross total resection was attempted in 67 patients and achieved in 62 (93%). Biopsy and cyst fenestration were the goals of surgery in 26 patients, and all were achieved as planned. Regarding outcomes, visual disturbance worsened in two patients (2%), endocrine status was aggravated in 34 (35%) patients, and new-onset diabetes insipidus occurred in 27 (41%) patients. The overall surgical complication rate (other than aggravation of visual or endocrine status) was 17%. Postoperative meningitis (12%) was the most common complication, followed by cerebrospinal fluid leakage (2%), vasospasm, hemorrhage and infarction. By pathological diagnosis, craniopharyngioma had the highest complication rate of 29%. All but one patient with postoperative hemorrhage showed no permanent deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ESS in children is feasible and relatively safe. More attention and different postoperative management protocols are required in children to avoid complications, especially in craniopharyngiomas. However, the complications can be mostly managed conservatively without permanent neurologic deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2022.769576","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T08:35:01Z","timestamp":1653640501000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Complications of Endoscopic Skull Base Surgery for Sellar and Parasellar Tumors in Pediatric Population; Neurosurgical Perspectives"],"prefix":"10.3389","volume":"12","author":[{"given":"Jeyul","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Hwy","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hoon","family":"Phi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Ki","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu-Chang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/BF02447290","article-title":"Instruments for Transnasal Brain Removal During Embalming by the Ancient Egyptians","volume":"6","author":"Pirsig","year":"1991","journal-title":"Int J anthropology"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.178.6.1781367","article-title":"Head and Skull Base Features of Nine Egyptian Mummies: Evaluation With High-Resolution CT and Reformation Techniques","volume":"178","author":"Hoffman","year":"2002","journal-title":"Am J Roentgenology"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2005.103.6.1096","article-title":"Harvey Cushing and Oskar Hirsch: Early Forefathers of Modern Transsphenoidal Surgery","volume":"103","author":"Cohen-Gadol","year":"2005","journal-title":"J Neurosurg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"315","DOI":"10.3340\/jkns.2017.0101.012","article-title":"Endoscopic Endonasal Approach for Suprasellar Lesions in Children: Complications and Prevention","volume":"60","author":"Kim","year":"2017","journal-title":"J Korean Neurosurgical Society"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1607314","article-title":"Injury of the Carotid Artery During Endoscopic Endonasal Surgery: Surveys of Skull Base Surgeons","volume":"79","author":"Rowan","year":"2018","journal-title":"J Neurological Surg Part B: Skull Base."},{"key":"B6","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/now207","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009\u20132013","volume":"18","author":"Ostrom","year":"2016","journal-title":"Neuro-oncology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-019-04335-5","article-title":"Endoscopic Endonasal Skull Base Surgery for Pediatric Brain Tumors","volume":"35","author":"Kim","year":"2019","journal-title":"Childs Nerv Syst"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3171\/JNS-07\/07\/0206","article-title":"History of Endoscopic Skull Base Surgery: Its Evolution and Current Reality","volume":"107","author":"Prevedello","year":"2007","journal-title":"J Neurosurg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0b013e3283401fdc","article-title":"Pediatric Endoscopic Skull Base Surgery","volume":"18","author":"Munson","year":"2010","journal-title":"Curr Opin Otolaryngol Head Neck surgery"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20964","article-title":"Anatomical Considerations for Endoscopic Endonasal Skull Base Surgery in Pediatric Patients","volume":"120","author":"Tatreau","year":"2010","journal-title":"Laryngoscope"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3171\/2013.10.PEDS13303","article-title":"Impact of Skull Base Development on Endonasal Endoscopic Surgical Corridors","volume":"13","author":"Banu","year":"2014","journal-title":"J Neurosurgery: Pediatrics"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27600","article-title":"Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes","volume":"129","author":"Kuan","year":"2019","journal-title":"Laryngoscope"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-019-04167-3","article-title":"Endonasal Endoscopic Skullbase Surgery in Children","volume":"35","author":"Deopujari","year":"2019","journal-title":"Child's Nervous System"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-005-1203-8","article-title":"Origin of Craniopharyngiomas: Implication on the Growth Pattern","volume":"21","author":"Wang","year":"2005","journal-title":"Childs Nerv Syst"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1093\/jnen\/nly083","article-title":"Pathological Relationship Between Adamantinomatous Craniopharyngioma and Adjacent Structures Based on QST Classification","volume":"77","author":"Liu","year":"2018","journal-title":"J Neuropathol Exp Neurol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3171\/2017.4.JNS162143","article-title":"Endoscopic Endonasal Approach for Craniopharyngioma: The Importance of the Relationship Between Pituitary Stalk and Tumor","volume":"129","author":"Dho","year":"2017","journal-title":"J Neurosurgery"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2010.06.014","article-title":"Surgical Outcome in 90 Patients With Craniopharyngioma: An Evaluation of Transsphenoidal Surgery","volume":"74","author":"Yamada","year":"2010","journal-title":"World Neurosurg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.wneu.2017.08.058","article-title":"Outcomes After Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population","volume":"108","author":"Patel","year":"2017","journal-title":"World neurosurgery"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyx570","article-title":"Adult Craniopharyngioma: Case Series, Systematic Review, and Meta-Analysis","volume":"83","author":"Dandurand","year":"2018","journal-title":"Neurosurgery"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1159\/000023536","article-title":"Thickened Pituitary Stalk on Magnetic Resonance Imaging in Children With Central Diabetes Insipidus","author":"Czernichow","year":"2000","journal-title":"Horm Res"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-014-0184-3","article-title":"Surgical Biopsies in Patients With Central Diabetes Insipidus and Thickened Pituitary Stalks","volume":"47","author":"Jian","year":"2014","journal-title":"Endocrine"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0187989","article-title":"Joint Approach Based on Clinical and Imaging Features to Distinguish non-Neoplastic From Neoplastic Pituitary Stalk Lesions","volume":"12","author":"Lee","year":"2017","journal-title":"PloS One"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-18-0634","article-title":"A Nationwide, Population-Based Epidemiologic Study of Childhood Brain Tumors in Korea, 2005-2014: A Comparison With United States Data","volume":"28","author":"Kang","year":"2019","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-020-01108-1","article-title":"Cephalocaudal Tumor Diameter Is a Predictor of Diabetes Insipidus After Endoscopic Transsphenoidal Surgery for non-Functioning Pituitary Adenoma","volume":"24","author":"Oh","year":"2021","journal-title":"Pituitary"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-014-2150-5","article-title":"Extended Endoscopic Endonasal Approach for Recurrent or Residual Adult Craniopharyngiomas","volume":"156","author":"Kim","year":"2014","journal-title":"Acta neurochirurgica"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2020.0231","article-title":"Multi-Layer Onlay Graft Using Hydroxyapatite Cement Placement Without Cerebrospinal Fluid Diversion for Endoscopic Skull Base Reconstruction","volume":"64","author":"Kim","year":"2021","journal-title":"J Korean Neurosurg Soc"},{"key":"B27","article-title":"Pediatric Endoscopic Endonasal Skull Base Surgery","author":"Singh","year":"2020"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1177\/159101991301900116","article-title":"Endovascular Management of Vascular Injury During Transsphenoidal Surgery","volume":"19","author":"\u00c7inar","year":"2013","journal-title":"Interventional Neuroradiology"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2011.06.014","article-title":"Training in Neurorhinology: The Impact of Case Volume on the Learning Curve","volume":"44","author":"Snyderman","year":"2011","journal-title":"Otolaryngologic Clinics North America"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2011.06.009","article-title":"Carotid Artery Injury After Endonasal Surgery","volume":"44","author":"Valentine","year":"2011","journal-title":"Otolaryngologic Clinics North America"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2015.09.009","article-title":"Injury of the Internal Carotid Artery During Endoscopic Skull Base Surgery: Prevention and Management Protocol","volume":"49","author":"AlQahtani","year":"2016","journal-title":"Otolaryngologic Clinics North America"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000430821.71267.f2","article-title":"Carotid Artery Injury During Endoscopic Endonasal Skull Base Surgery: Incidence and Outcomes","volume":"73","author":"Gardner","year":"2013","journal-title":"Operative Neurosurgery"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-818489","article-title":"Hemorrhagic Vascular Complications of Endoscopic Transsphenoidal Surgery","volume":"47","author":"Cavallo","year":"2004","journal-title":"min-Minimally Invasive Neurosurgery"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1159\/000091586","article-title":"Vascular Injury and Transsphenoidal Surgery","volume":"34","author":"Oskouian","year":"2006","journal-title":"Pituitary Surgery-A Modern Approach"},{"key":"B35","doi-asserted-by":"publisher","first-page":"ONS","DOI":"10.1227\/01.NEU.0000255408.84269.A8","article-title":"Avoidance of Carotid Artery Injuries in Transsphenoidal Surgery With the Doppler Probe and Micro-Hook Blades","volume":"60","author":"Dusick","year":"2007","journal-title":"Operative Neurosurgery"},{"key":"B36","first-page":"28","article-title":"Injury to the Cavernous Segment of the Internal Carotid Artery Upon Transsphenoidal Endoscopic Removal of Pituitary Adenomas (Report of 4 Cases)","volume":"77","author":"Kalinin","year":"2013","journal-title":"Zh Vopr Neirokhir Im NN Burdenko."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1161\/hs1201.099892","article-title":"Collateral Ability of the Circle of Willis in Patients With Unilateral Internal Carotid Artery Occlusion: Border Zone Infarcts and Clinical Symptoms","volume":"32","author":"Hendrikse","year":"2001","journal-title":"Stroke"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3171\/2018.8.PEDS18183","article-title":"Long-Term Impact of Pediatric Endoscopic Endonasal Skull Base Surgery on Midface Growth","volume":"23","author":"Chen","year":"2019","journal-title":"J Neurosurgery: Pediatrics"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000516236","article-title":"Influence of Pediatric Endoscopic Endonasal Skull Base Resections on Midface and Skull Base Development","volume":"56","author":"Oviedo","year":"2021","journal-title":"Pediatr Neurosurgery"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.769576\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T08:35:07Z","timestamp":1653640507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.769576\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,27]]},"references-count":39,"alternative-id":["10.3389\/fonc.2022.769576"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.769576","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,27]]},"article-number":"769576"}}