Use of a Multiportal Endoscopic Transnasal and Transorbital Approach for Pediatric Skull Base Neoplasms: Case Series and Literature Review

Background: Lesions of the pediatric skull base can involve multiple sinonasal and intracranial compartments, posing unique surgical challenges due to limited pneumatization, immature bony structures, and the need to balance oncologic control with functional preservation and cosmetic outcomes. Combining endoscopic endonasal and transorbital corridors allows for multiple visual vectors and instrument triangulation without the need for open transcranial or transfacial approaches. Use of this strategy has not been widely reported in the pediatric literature. Objective: To present a pediatric case series of multiportal endoscopic transnasal and transorbital approaches for skull base lesions, highlighting technical nuances, outcomes, and a review of the limited pediatric literature. Methods: An IRB-approved single institutional retrospective cohort study of pediatric patients (