(A848) Pediatric Middle Fossa Craniotomy: Institutional Experience and Surgical Outcomes

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

Krish Suresh, MD

Neurotology Fellow
University of California San Diego
San Diego, California, United States

Co-Author(s)

MB

Michael G. Brandel, MD

University of California San Diego, United States
Douglas M. Bennion, MD PhD

Assistant Professor
University of Iowa
Iowa City, Iowa, United States
MS

Marc S. Schwartz, MD

Professor of Neurosurgery
University of California San Diego
La Jolla, CA, United States
ML

Michael Levy, MD PhD

University of California San Diego, United States

Senior Author(s)

RF

Rick A. Friedman, MD PhD

Professor of Otolaryngology and Neurosurgery
University of California San Diego
La Jolla, California, United States

Disclosure(s):

Krish Suresh, MD: No relevant relationships to disclose.

Douglas M. Bennion, MD PhD: No relevant relationships to disclose.

Rick A. Friedman, MD PhD: No relevant relationships to disclose.

Introduction: Middle fossa craniotomy (MFC) with exposure of the internal auditory canal and/or petrous apex (anterior petrosectomy) is an uncommon operation in the pediatric population. Here, we report our institution’s experience and surgical outcomes with pediatric MFC.

Methods: We conducted a retrospective review for MFC with exposure of the internal auditory canal and/or petrous apex performed at our institution from 2018-2024 in patients aged 18 and under. Data collected included demographics, office visits, surgery and inpatient stay, audiometrics, and imaging.

Results: There were 16 patients who met our inclusion criteria. Median age was 12 years (range 1-18), 10 (63%) were male. The pathology treated was: 9 (56%) VS, of which 7 were neurofibromatosis 2 (NF2); and 1 (6%) each of grade I meningioma, clear cell meningioma, epidermoid cyst, cavernous malformation, atypical teratoid rhabdoid tumor, anaplastic ependymoma, prepontine abscess. On preoperative MRI, median tumor size was 12.5 mm (range 3-63). Gross total resection was achieved in 11 (69%) cases, near total in 1 (6%), and subtotal in 4 (25%). There was 1 (6%) case of CSF leak. Median length of stay was 3 days. Sixth nerve palsy was sustained in 3 (19%) cases. Facial nerve outcomes were favorable: of 11 patients with preoperative House-Brackmann (HB) I, 10 (91%) maintained HB1 postoperatively. For VS, hearing outcomes were evaluated: Preoperatively, all patients had class A hearing. At first postoperative follow-up (median 8 days), 5 (56%) maintained class A hearing and 4 (44%) were class D. At latest follow-up (median 678 days), of the 5 patients with preserved hearing, 4 maintained class A hearing, and the other one progressed to class B. On follow-up MRI (median 172 days), 7 (50%) had no evidence of disease, 1 (7%) had linear enhancement, and 6 (43%) had nodular enhancement. Of the 6 with nodular enhancement, 5 had NF2.

Conclusions: Pediatric MFC can be used to approach a variety of intracranial pathologies. VS in NF2 is the most common indication and has favorable facial nerve outcomes and hearing preservation rates similar to those in adult NF2.