Complication Rates and Predictors in Pediatric Skull Base Surgery

Introduction: Pediatric skull base surgeries pose unique challenges due to complex anatomy, small surgical corridors, and limited applicability of standard postoperative precautions, with sparse data on complication rates in this population. This study aims to investigate complication rates and their predictors in pediatric skull base surgeries, providing actionable insights for improved outcomes.

Methods: This retrospective study reviewed records of children undergoing skull base surgeries from 2007 to 2024 at a single pediatric institution. Data were collected on demographics, diagnoses, surgical techniques, and postoperative outcomes. Complications were categorized by clinical impact, and predictive factors were evaluated using multivariate logistic regression.

Results: A total of 93 children underwent skull base surgery: 85 (91.4%) endoscopic and 8 (8.6%) open. Median age was 12.8 years (8 months–18 years). Diagnoses included juvenile nasopharyngeal angiofibroma (23.3%), encephaloceles (8.6%), pituitary adenoma (8.6%), and others. Complications occurred in 31.3% of cases, with infection (17%), high urine output (14.6%), hormonal dysfunction (12%), and CSF leaks (12%) being most common. CSF leaks were more frequent in encephaloceles (40%) and craniopharyngiomas (28%), while hormonal dysfunction was prevalent in pituitary-related cases. Surgeries >6 hours had higher complication rates (62.5% vs. 20%, p=0.015). Endoscopic approaches had fewer complications (18.2% vs. 50%, p=0.048). Age and sex were not significant predictors

Conclusions: Pediatric skull base surgeries carry significant risks, particularly for diagnoses like encephaloceles and craniopharyngiomas. Emphasizing minimally invasive techniques and careful surgical planning can reduce complications. Future efforts should prioritize preoperative risk stratification and multidisciplinary care to enhance outcomes.