Early Initiation of Adjuvant Therapy Following Pediatric Endoscopic Endonasal Surgery for Tumors.
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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.