# Ependymoma — GCMD Library living collection

Everything in the library about ependymoma — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 90 cited statements

## Episodes
### Surgical Management
- [Pediatric Endoscopic Skull Base Surgery: Collaborative Approaches and Techniques](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374) — video · 24:46 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374.md)
- [Pediatric Endonasal Skull Base Surgery: Pediatric Endoscopic Neurosurgery 2018](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379) — video · 24:46 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379.md)
- [Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380) — video · 21:33 · [machine version](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=0) Introduction and Importance of Collaboration in Pediatric Endoscopic Skull Base Surgery (Ep 1)
- [7:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=420) Skull Base Development and Anatomical Considerations (Ep 1)
- [12:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=720) Transnasal and Transfrontal Approaches: Encephaloceles and Clival Lesions (Ep 1)
- [15:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=900) Transsphenoidal Approaches and Craniopharyngiomas (Ep 1)
- [18:20](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1100) Outcomes Data and Additional Approaches (Ep 1)
- [21:57](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1317) Q&A: Anatomical Limitations, Encephalocele Management, and Fluorescein Use (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=0) Introduction and Importance of Collaboration (Ep 2)
- [4:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=240) Skull Base Development and Anatomical Considerations (Ep 2)
- [8:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=480) Transnasal and Transfrontal Approaches (Ep 2)
- [10:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=600) Transsphenoidal Approaches and Sphenoid Drilling Technique (Ep 2)
- [15:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=900) Extended Approaches: Transethmoidal and Transmaxillary (Ep 2)
- [18:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1100) Craniopharyngioma Management and Outcomes (Ep 2)
- [21:57](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1317) Question and Answer Session (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=0) Introduction and Framework: Pediatric Perspective on Endoscopic Skull Base Surgery (Ep 3)
- [7:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420) Continuum of Minimally Invasive Approaches and Pathology Categorization (Ep 3)
- [11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700) Transclival Transodontoid Approach for Craniocervical Junction Abnormalities (Ep 3)
- [16:25](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=985) Q&A: Positioning, Staging, Equipment, and Practical Considerations (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Endoscopic skull base surgery was slow to propagate into the pediatric world despite evolving as an adult specialty." (clinical) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=0)
- "Many pediatric neurosurgeons felt there wasn't enough room and hadn't had enough training in endoscopic skull-based techniques." (opinion) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=180)
- "Strong collaboration between pediatric neurosurgery and adult endoscopic skull base surgery is the key to program success." (opinion) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=240)
- "Children are not just little adults - there are unique special things about the pediatric population that adult surgeons may not be aware of or able to manage as well as pediatric neurosurgeons." (clinical) [Ep 1 · 5:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=300)
- "Age 4 and above is a comfortable threshold after which most endoscopic skull base procedures can be performed, though younger is possible." (clinical) [Ep 1 · 9:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=540)
- "In the pediatric population, the conchal type of sphenoid sinus is most common, and this enlarges over time." (clinical) [Ep 1 · 10:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=600)
- "Even with a conchal sphenoid sinus, much of the bone in the middle of the sphenoid is very soft and can be easily drilled out with a diamond drill to create a pneumatized sphenoid sinus." (clinical) [Ep 1 · 11:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=660)
- "After age 4, most conchal sphenoid sinuses are eliminated based on radiographic studies." (clinical) [Ep 1 · 12:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=720)
- "Inter-carotid distance increases from 12-13 millimeters at age 5 to about 15 millimeters at age 15, but this 2-3 millimeter difference doesn't make a dramatic difference to surgical procedures." (clinical) [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=780)
- "100% of encephaloceles are now done using an endonasal approach, even fairly large ones, whereas traditionally these would be removed with a bifrontal craniotomy." (clinical) [Ep 1 · 15:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=900)
- "For encephalocele repair, intrathecal fluorescein is given, a lumbar drain is placed, and all encephalocele tissue must be resected until gone, with cauterization of the edges." (clinical) [Ep 1 · 16:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=960)
- "The closure technique for encephaloceles involves an inlay of Duragard on the inside, then an onlay of fat and a nasal septal flap." (clinical) [Ep 1 · 17:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1020)
- "For encephaloceles, a lumbar drain is left in for a couple of days postoperatively because some patients have increased intracranial pressure, allowing pressure decrease while the closure tightens." (clinical) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080)
- "In pediatric patients, a small rim of craniopharyngioma tumor is often intentionally left on the hypothalamus to avoid causing morbid obesity and cognitive maldevelopment." (clinical) [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140)
- "The endonasal view for craniopharyngiomas provides better visualization of the stalk, third ventricle, and hypothalamus with less retraction on optic nerves and brain compared to transcranial approaches." (clinical) [Ep 1 · 20:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1200)
- "For craniopharyngiomas, the surgical goal is to save the pituitary stalk as long as possible, but if the stalk is completely infiltrated, it will be sacrificed to achieve cure." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "Superior hypophyseal arteries should be preserved during craniopharyngioma surgery because they feed superiorly to the chiasm, and their sacrifice could cause visual loss." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "The endonasal approach for craniopharyngiomas results in no retraction of the brain, so there is no FLAIR signal in the brain after tumor removal." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "Comparing endonasal to transcranial surgery for craniopharyngiomas, the extent of resection for endonasal surgery is greater than for transcranial surgeries." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "Visual outcome after endonasal surgery for craniopharyngiomas is better than after transcranial surgery because the approach is from below without manipulation of optic nerves." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "In a series of 85 craniopharyngioma patients, gross total resection rate was 86%, greater than 95% resection achieved in 95% of patients, visual improvement in 78%, and CSF leak rate 2.4%." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "For craniopharyngiomas, diabetes insipidus and panhypopituitarism are common when pursuing gross total resection." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "In 11 pediatric craniopharyngioma patients (average age 8 years), gross total resection rate was 45%, but intentional subtotal resection is often the goal in the pediatric population." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "In the pediatric craniopharyngioma series, visual function was stable or improved in over 70%, and all children except one returned to an academic environment, with 10 in a grade appropriate for age." (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1260)
- "Craniopharyngiomas in the pediatric age group are mostly adamantinomatous type, more likely in the sella, and more likely calcified, while adults have both adamantinomatous and papillary types." (clinical) [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140)
- "Papillary craniopharyngiomas with BRAF mutation are more likely suprasellar and less likely calcified." (clinical) [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1140)
- "Juvenile nasopharyngeal angiofibromas are very vascular tumors that are typically embolized beforehand but still bleed quite a bit during surgery." (clinical) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080)
- "Most juvenile nasopharyngeal angiofibromas arise from the pterygopalatine fossa, requiring wide exposure of the back wall of the maxillary sinus." (clinical) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1080)
- "For encephalocele repair, the approach is to first repair the encephalocele and see if it holds; shunting is only performed for patients with recurrent encephaloceles or clear hydrocephalus." (clinical) [Ep 1 · 23:13](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1393)
- "Patients are placed on acetazolamide for about 2 weeks after encephalocele repair to ensure healing." (clinical) [Ep 1 · 23:13](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1393)
- "Out of approximately 40 encephalocele cases, 3 or 4 patients required shunting postoperatively." (clinical) [Ep 1 · 23:38](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1418)
- "Intrathecal fluorescein protocol uses a low dose of 0.3mL of 10% fluorescein diluted in 10cc of CSF, with pretreatment using Decadron and Benadryl." (clinical) [Ep 1 · 23:58](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1438)
- "Literature has shown adverse effects to high doses of intrathecal fluorescein, but with low-dose protocol and steroid pretreatment, no allergic reactions or arachnoiditis have been observed." (clinical) [Ep 1 · 23:58](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1438)
- "The same instruments, scope holder, and scopes used in adult endoscopic skull base surgery are used in pediatric cases." (clinical) [Ep 1 · 22:22](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1342)
- "When nostril width is a concern, the irrigation sheath can be removed from the scope, reducing its diameter from 4 millimeters to 2.7 millimeters." (clinical) [Ep 1 · 22:22](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1342)
- "Other than age less than 4, there are no significant anatomical concerns in the pediatric population for endoscopic skull base surgery beyond the perceived limitations of limited nares size and non-pneumatized sinuses." (clinical) [Ep 1 · 21:57](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1317)
- "The long-term implications of arrested skull base growth in a child with lack of pneumatization 10 years down the road are unknown, though followed patients have not shown long-term problems." (clinical) [Ep 1 · 24:20](https://qa.library.globalcastmd.com/watch/pediatric-endoscopic-skull-base-surgery-collaborative-approaches-and-techniques-374?t=1460)
- "The goal of surgery in craniopharyngioma in the pediatric population is sometimes biopsy followed by radiation, different from adult paradigms where gross total resection may be the goal." — Greenfield (clinical) [Ep 3 · 0:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=0)
- "Intraventricular endoscopy has limitations including subpar optics compared to air medium and issues with hemorrhage obscuring the view in a fluid medium." — Greenfield (clinical) [Ep 3 · 7:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "Endoscopic-assisted approaches in an air medium provide much better optics and the ability to do bimanual manipulation of tissues compared to fluid-medium intraventricular approaches." — Greenfield (clinical) [Ep 3 · 7:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "Pediatric skull base lesions can be categorized into four groups: benign neoplastic lesions, malignant neoplastic lesions, congenital malformations, and iatrogenic or traumatic defects." — Greenfield (clinical) [Ep 3 · 7:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "Five key considerations for endoscopic cases in children are: nasal aperture size (can limit bimanual operation), pneumatization, skull maturation, intercarotid distance, and defect closure." — Greenfield (clinical) [Ep 3 · 7:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "The pathology of craniopharyngioma in children is very different molecularly and genetically than it is in adults." — Greenfield (clinical) [Ep 3 · 7:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy." — Greenfield (clinical) [Ep 3 · 7:00](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=420)
- "The transclival transodontoid approach has transitioned from a traditional transoral approach to what is exclusively now an endoscopic endonasal approach in the speaker's practice." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "Advantages of the endoscopic endonasal approach for odontoid resection include the ability to extubate early and begin feeding early, seen in both adult and pediatric populations." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "Odontoid resections are almost always done in conjunction with posterior fossa decompression and cervical instrumentation because of the instability that ensues from odontoid resection." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "A linear incision in the retropharyngeal fascia works well for transodontoid approach, as long as suction is used to retract contralateral soft tissue; this replaced an earlier U-shaped incision technique." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "The closure for transodontoid approach is simple: flow seal in the cavity and re-approximation of retropharyngeal fascia with one or two single interrupted stitches through a single nasal approach." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "In the speaker's series of 10 odontoid resection patients, all are extubated on day 0 or 1, with early extubation now attempted on the same day of surgery." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "One early reintubation in the odontoid series was due to aspiration of a sealant, which is no longer used because it was redundant and unnecessary due to lack of CSF leak." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "Pre-operative CTA or MRA is sometimes part of the workup for odontoid resection to identify and navigate the carotid arteries throughout the case." — Greenfield (clinical) [Ep 3 · 11:40](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=700)
- "The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges." — Greenfield (clinical) [Ep 3 · 16:25](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=985)
- "The practice has not yet incorporated a sublabial approach to the sphenoid sinus in pediatric cases." — Greenfield (clinical) [Ep 3 · 18:29](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1109)
- "There is a steep learning curve for endoscopic endonasal surgery in young children due to ergonomic challenges of getting the scope and two instruments working together in tight spaces." — Greenfield (clinical) [Ep 3 · 18:29](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1109)
- "Endonasal equipment and scopes are designed to work in very small spaces and work well in the pediatric nose; while it is a little tighter, it is not so tight that cases cannot be done, and the practice has never had to avoid using an instrument because the nose was too small." — Schwartz (clinical) [Ep 3 · 19:30](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1170)
- "Application-specific equipment and scope technology for endoscopic neurosurgery has evolved to meet demands, with the armamentarium for skull base work being distinctly different from that used for intraventricular work." (host_summary) [Ep 3 · 20:01](https://qa.library.globalcastmd.com/watch/relevance-of-skull-base-surgery-to-pediatric-neurosurgery-pediatric-380?t=1201)
- "Age 4 and above is generally a comfortable threshold for pediatric endonasal skull base surgery, though procedures are possible at younger ages." (clinical) [Ep 2 · 4:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=240)
- "In pediatric patients, conchral (non-pneumatized) sphenoid sinuses can be converted to pneumatized sinuses by drilling out soft, vascular bone in the middle with a diamond drill until reaching harder bone over the carotid artery and planum." (clinical) [Ep 2 · 6:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=360)
- "After age 4, most conchral sphenoid sinuses are eliminated, with progressive pneumatization occurring over time." (clinical) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=420)
- "The intercarotid distance increases from approximately 12-13 millimeters at age 5 to about 15 millimeters at age 15, but this 2-3 millimeter difference does not dramatically affect surgical feasibility." (clinical) [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=450)
- "Essentially 100% of encephaloceles are now managed using an endonasal approach rather than bifrontal craniotomy." (clinical) [Ep 2 · 9:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=540)
- "For encephalocele repair, intrathecal fluorescein is administered, a lumbar drain is placed, all encephalocele tissue is resected and cauterized back to the edges, and closure is performed with inlay Duragen, onlay fat, and nasal septal flap." (clinical) [Ep 2 · 9:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=560)
- "Lumbar drains are left in place for a couple of days after encephalocele repair because some patients have increased intracranial pressure, allowing pressure reduction while the closure tightens." (clinical) [Ep 2 · 9:50](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=590)
- "In pediatric craniopharyngioma surgery, a small rim of tumor is often intentionally left on the hypothalamus to avoid causing morbid obesity and cognitive maldevelopment." (clinical) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=720)
- "Craniopharyngiomas have two age peaks of presentation; pediatric cases are mostly adamantinomatous type, more likely in the sella, and more likely calcified, while adult cases include both adamantinomatous and papillary types." (clinical) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1100)
- "Papillary craniopharyngiomas with BRAF mutation are more likely suprasellar and less likely calcified." (clinical) [Ep 2 · 18:40](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1120)
- "The endonasal view for craniopharyngioma provides better visualization of the stalk, third ventricle, and hypothalamus with less retraction on optic nerves and brain compared to transcranial approaches." (clinical) [Ep 2 · 19:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1140)
- "In craniopharyngioma surgery, the pituitary stalk is preserved when possible, but is sacrificed if completely infiltrated with tumor in favor of achieving a cure." (clinical) [Ep 2 · 20:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1200)
- "Superior hypophyseal arteries should be preserved during craniopharyngioma surgery because they feed the chiasm superiorly, which is critical for preventing visual loss." (clinical) [Ep 2 · 20:10](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1210)
- "After endonasal craniopharyngioma resection, there is no flare signal in the brain on postoperative imaging because there is no brain retraction during the procedure." (clinical) [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1260)
- "In a series of 85 craniopharyngioma patients, gross total resection was achieved in 86%, with greater than 95% resection in 95% of patients." (epidemiological) [Ep 2 · 21:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1290)
- "Visual improvement occurred in 78% of craniopharyngioma patients after endonasal surgery." (epidemiological) [Ep 2 · 21:40](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1300)
- "The CSF leak rate in the craniopharyngioma series was 2.4%." (epidemiological) [Ep 2 · 21:45](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1305)
- "Diabetes insipidus and panhypopituitarism are fairly frequent outcomes when pursuing gross total resection of craniopharyngioma." (clinical) [Ep 2 · 21:50](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1310)
- "In 11 pediatric craniopharyngioma patients (average age 8 years), gross total resection rate was 45%, but intentional subtotal resection is often the goal in the pediatric population." (epidemiological) [Ep 2 · 21:57](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1317)
- "In the pediatric craniopharyngioma series, only 2 patients had greater than 9% increase in BMI, visual function was stable or improved in over 70%, and all children except one returned to an academic environment with 10 in grade-appropriate settings." (epidemiological) [Ep 2 · 22:10](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1330)
- "Complications in the pediatric craniopharyngioma series included 1 CSF leak, 1 visual loss, and 1 abscess." (epidemiological) [Ep 2 · 22:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1350)
- "Extent of resection for craniopharyngioma is greater with endonasal surgery compared to transcranial approaches." (epidemiological) [Ep 2 · 21:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1280)
- "Visual outcomes after endonasal craniopharyngioma surgery are better than after transcranial surgery because the approach is from below without manipulation of the optic nerves." (clinical) [Ep 2 · 21:25](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1285)
- "Juvenile nasopharyngeal angiofibromas are very vascular tumors that are typically embolized beforehand but still bleed quite a bit during surgery." (clinical) [Ep 2 · 14:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=870)
- "Most juvenile nasopharyngeal angiofibromas arise from the pterygopalatine fossa, requiring wide exposure of the back wall of the maxillary sinus." (clinical) [Ep 2 · 14:50](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=890)
- "For encephaloceles associated with intracranial hypertension, the approach is to first repair the encephalocele and see if it holds, placing patients on acetazolamide for about 2 weeks postoperatively." (clinical) [Ep 2 · 23:13](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1393)
- "Shunting for encephaloceles is reserved for patients with clearly evident hydrocephalus or those with recurrent encephaloceles after initial repair." (clinical) [Ep 2 · 23:20](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1400)
- "Out of approximately 40 encephalocele cases, shunting was required 3 or 4 times." (epidemiological) [Ep 2 · 23:38](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1418)
- "Intrathecal fluorescein is administered at a low dose of 0.3 mL of 10% fluorescein diluted in 10 cc of CSF, with pretreatment using Decadron and Benadryl to prevent adverse effects." (clinical) [Ep 2 · 23:58](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1438)
- "Literature has shown adverse effects including allergic reactions and arachnoiditis with high doses of intrathecal fluorescein, but low-dose protocols with steroid pretreatment have not resulted in such problems in the speaker's experience." (clinical) [Ep 2 · 24:05](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1445)
- "The same instruments, scopes, and scope holders used in adult endonasal surgery are used in pediatric cases." (clinical) [Ep 2 · 22:40](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1360)
- "When nostril width is limiting, the irrigation sheath can be removed from the endoscope, reducing the diameter from 4 millimeters to 2.7 millimeters." (clinical) [Ep 2 · 22:30](https://qa.library.globalcastmd.com/watch/pediatric-endonasal-skull-base-surgery-pediatric-endoscopic-neurosurgery-2018-379?t=1350)

## Changelog
- Sep 15: 3 items added automatically

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