Pediatric middle fossa craniotomy for tumors of the lateral skull base: Institutional experience and surgical outcomes.
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OBJECTIVE: 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. We report our institution's experience and surgical outcomes with pediatric MFC. METHODS: Retrospective case series including all MFC with exposure of the internal auditory canal and/or petrous apex, performed between May 2018 and September 2024, in patients aged 18 years and younger. Primary outcome measures were pre-operative and postoperative facial nerve function and hearing status. RESULTS: Sixteen patients met inclusion criteria. Median age was 12 years (range 1-18), 10 (63%) were male and six (37%) were female. 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%). Facial nerve outcomes were favorable: of 11 patients with preoperative House-Brackmann (HB) I, 10 (91%) maintained HBI postoperatively. All 9 patients with vestibular schwannoma (VS) had class A hearing preoperatively. At first postoperative follow-up (median 8 days), five (56%) maintained class A hearing and four (44%) were class D. CONCLUSIONS: MFC can be safely performed in children for appropriately selected skull base lesions. VS in NF2 is the most common indication, and MFC offers a valuable hearing-preserving option in these cases. Early intervention for small, growing tumors with associated hearing loss, coupled with modern intraoperative monitoring and multidisciplinary expertise, allow for facial nerve and hearing outcomes similar to the adult population.