Introduction: This study investigates how patient age relates to clinical characteristics and outcomes in endoscopic endonasal surgery (EES). The research considers the age-varying incidence of anatomic factors, pathology, cerebrospinal fluid (CSF) diversion, reconstruction, and complications.
Methods: Patients were included if they underwent EES at a single tertiary pediatric center between 1999 and 2022. Age was categorized as 1-6, 7-12, and 12-18. Anatomic variables included sellar pneumatization pattern and inter-carotid distance. Differences between age groups were compared using Pearson’s Chi-squared test and analysis-of-variance.
Results: There was no difference in sex distribution or in the proportion of patients who presented with recurrent pathology (age 1-6: 16%, age 7-12: 28%, age 13-18: 22%, p=0.36).
There were significant age-dependent differences in pathology. In younger patients, pathology was more likely to be in the anterior fossa (42%, 8%, 11%, p<0.001) and less likely in the coronal plane (8%, 40%, 35%, p<0.001).Younger patients were more likely to present with craniopharyngioma (29%, 21%, 7%, p<0.001), encephalocele (29%, 4%, 3%, p<0.001), or dermoid/epidermoid (8%, 0%, 2%, p=0.046). Older patients were more likely to present with juvenile nasopharyngeal angiofibroma (JNA) (0%, 28%, 24%, p=0.001), pituitary adenoma (0%, 0%, 13%, p=0.001), or Rathke cleft cyst (0%, 4%, 11%, p=0.045). Patients aged 7-12 were most likely to present with basilar invagination/odontoid pannus (3%, 9%, 2%, p=0.043).
Concordant with age-related differences in pathology, there were differences in combination approaches. Older patients were more likely to have concomitant anterior transmaxillary approach (0%, 11%, 13%, p=0.073) and preoperative embolization (0%, 19%, 17%, p=0.019). Patients aged 7-12 were most likely to have posterior cervical fixation (0%, 11%, 3%, p=0.018), consistent with the greater proportion of basilar invagination cases in this age group. ). There were no differences CSF diversion (34%, 34%, 24%, p=0.215) or pedicled vascularized flap (45%, 43%, 45%, p=0.97).
There was considerable anatomic variation across age groups. Mean inter-carotid distance increased with age(12mm, 13mm, 14mm, p=0.001). With respect to sphenoid sinus pneumatization, younger patients were more likely to have a conchal pattern (32%, 0%, 1%, p<0.001) and older patients were more likely to have a post-sellar pattern (5%, 42%, 66%, p<0.001).
In patients with tumors (n=177), older patients were more likely to have gross-total resection (52%, 70%, 81%, p=0.012). There were no differences in frequency of complications in aggregate (13%, 17%, 13%, p=0.7) or individually as CSF leak (15%, 26%, 18%, p=0.59), hemorrhage (3%, 2%, 3%, p=0.95), or major vascular injury (0%, 4%, 1%, p=0.33). There were no differences in permanent new cranial nerve dysfunction (5%, 13%, 8%, p=0.76) or visual deficit (3%, 2%, 1%, p=0.53). Younger patients demonstrated a trend toward more permanent new diabetes insipidus (16%, 9%, 5%, p=0.085) and more permanent new panhypopituitarism (16%, 6%, 7%, p=0.13), which corresponds to the increased proportion of craniopharyngioma cases.
Conclusion: These findings underscore the effectiveness of EES in pediatric patients across a spectrum of age groups. EES can be safely performed in patients of all age ranges, despite variations in pathology and anatomy, without any discernible difference in complication rates.