Authors :
Presenting Author: Michael Baumgartner, MD, PhD – University of California, San Francisco
Samuel Tomlinson, MD – Hospital of the University of Pennsylvannia
Roshan Warman, BS – University of Pennsylvania
Kathleen Galligan, PA-C – Children's Hospital of Philadelphia
Benjamin Kennedy, MD – Children's Hospital of Philadelphia
Rationale:
Minimally-invasive anterior skull base approaches utilizing trans-orbital or endonasal corridors are increasingly popular in modern neurosurgery. These approaches offer significant advantages such as avoiding traversing or retracting on brain, improved cosmesis, minimal temporalis muscle disruption, and reduced blood loss, but are limited by narrow corridors and less familiar anatomy. Few studies have examined the safety and outcomes of minimally-invasive anterior skull base approaches for seizure focus resection in children.
Methods:
A retrospective study was conducted of patients who underwent trans-orbital craniotomy (trans-ciliary or trans-palpebral) or endoscopic endonasal approach at the Children’s Hospital of Philadelphia by a single surgeon between September 2022 and April 2025. Clinical data collected included seizure etiology, imaging findings, pathology, anti-seizure medications, complications, cosmetic outcomes, and post-operative seizure burden.
Results:
Nine patients were examined (median age: 5 years, range: 2-18 years): 6 trans-ciliary eyebrow orbitofrontal craniotomies, 2 trans-palpebral orbitozygomatic craniotomies, and 1 endoscopic endonasal resection. Gross total resection was achieved in all cases. Pathologic diagnoses included hamartoma (n=2), pleomorphic xanthroastrocytoma (n=2), polymorphous low grade neuroepithelial tumor of the young (PLENTY; n=1), focal cortical dysplasia Ia (n=1), dysembryoplastic neuroepithelial tumor (n=1), low-grade glioneuronal tumor (n=1), and increased neurons in white matter (n=1). No cases of postoperative hydrocephalus or shunt placement were observed. 1 patient (11%) developed incisional cerebrospinal fluid leak requiring external ventricular drainage but no shunt. At an average follow-up of 20 months (median 23, range 1-34 months), 8/9 patients (89%) were seizure-free (Engel 1). Cosmetic outcome was exceptional in all cases.Conclusions:
Minimally-invasive trans-orbital and endonasal approaches can be successfully employed for resection of anterior skull base lesions associated with drug-resistant epilepsy in children, resulting in excellent seizure outcomes, favorable cosmesis, and reduced manipulation of surrounding brain. Funding: No funding directly supported this research