The removal of skull base brain tumors in children is both difficult and risky because it can cause long-term disruption of facial growth centers — resulting not only in damage to neural tissues such as the optic nerve and carotid artery, but also causing possible permanent cosmetic disfiguration. However, a nasal endoscopic technique may provide a safer, less damaging and less invasive approach for treating the lesions in some children.Drs. Amin Kassam, Carl Snyderman and Ricardo Carrau and their colleagues at the University of Pittsburgh School of Medicine investigated the effects of their expanded endonasal approach for removing tumors in 25 patients who were 18 years old or younger. As reported in the February issue of the Journal of Neurosurgery, the physicians first identified the area containing the tumor using high-resolution CT angiography and MR imaging. Then they inserted a 4-mm round endoscope and suction via each patient’s right nostril and a dissecting instrument via the left nostril. They removed the tumors using surgical tools — many of which were developed in-house for this procedure. The tumors were removed in all 25 patients, and none suffered any neurological damage, vascular injury or central nervous system infection. The researchers believe that their results indicate that the endonasal endoscopic technique offers increased visualization and exposure of target tumors and should be considered as an effective and safe treatment option for removing skull base brain tumors in children. They caution that performing these procedures, especially in children, requires years of experience.