Early Initiation of Adjuvant Therapy Following Pediatric Endoscopic Endonasal Surgery for TumorsOA

Objective:To evaluate complication rates of early adjuvant therapy initiation in pediatric patients with endoscopic endonasal resection for skull base tumors.Design:Retrospective case series of pediatric patients(0–18 years old)with skull base tumors who underwent endoscopic endonasal resection between 2013 and 2023.The median follow-up was 4.21 years.Setting:Single,urban academic pediatric center.Participants:Patients who received radiation within 3 months and/or chemotherapy within 2 weeks of endoscopic endonasal resection.Main Outcome Measures:Primary outcomes were perioperative and adjuvant therapy-related complications including reconstruction failure.Secondary outcomes were recurrence and overall survival.Results:This study included 16 patients(radiation[n=10];chemoradiation[n=2];chemotherapy[n=4])with a variety of tumor types and high dural reconstruction rate(93.8%,n=15).The average time to radiation was 39 days.The average time to chemotherapy was 9.5 days.The most common reconstructive method included nasoseptal flap and nasoseptal flap plus fat/tensor fascia lata.No patients in either group experienced cerebrospinal fluid(CSF)leaks postoperatively or during adjuvant therapy.Only one patient experienced a recurrence post-resection,and overall survival at the median follow-up time was 91%.Conclusions:A majority of our patient cohort experienced intraoperative CSF leaks resulting in a high rate of complex endonasal reconstructions.Adjuvant treatment postoperatively did not incur significant complications,despite initiation of radiation as early as postoperative day 1 or chemotherapy as early as postoperative day 0,demonstrating preliminary support of the safety of early adjuvant therapy initiation following endoscopic endonasal procedures in the pediatric skull base tumor population.