Transnasal endoscopic surgery in the complex treatment of children with parameningeal rhabdomyosarcoma

Introduction. Malignant tumors of the parameningeal region are neoplasms with varying morphologies. The most common malignant tumors of this location are rhabdomyosarcoma, esthesioneuroblastoma, and undifferentiated carcinoma. Rhabdomyosarcoma is the most common soft tissue sarcoma. The incidence rate of rhabdomyosarcoma is 0.9 per 100,000 children. According to the Children's Oncology Group, comprehensive, intensive antitumor treatment, including multiagent chemotherapy, radiation therapy, and modern surgical technologies, has increased overall 5-year survival rates to 70 %. Developing in these anatomical structures, rhabdomyosarcoma involves several adjacent anatomical areas, including the visual system and the brain. Treatment of children with parameningeal rhabdomyosarcoma requires not only achieving oncological radicality but also minimizing the long-term consequences of therapy that impact quality of life. In this context, the choice of surgical approach – between traditional open surgeries and transnasal endoscopic surgery – takes on particular importance. Open approaches, despite their effectiveness, carry the risk of damaging the facial growth plates and causing significant cosmetic defects. However, transnasal endoscopic surgery avoids these drawbacks while ensuring adequate oncologic control, making it an increasingly preferred method in pediatric practice.

The aim of the study – demonstratation of the capabilities and advantages of transnasal endoscopic surgery in the treatment of children with parameningeal rhabdomyosarcoma.

Materials and methods. The study included 36 patients aged 9 months to 14 years diagnosed with parameningeal rhabdomyosarcoma who underwent specialized treatment between 2017 and 2022. Boys predominated – 20 (56 %). All patients underwent surgical treatment at the Research Institute of Preschool Education and Gynecology, N.N. Blokhin National Medical Research Center, Ministry of Health, Russia.

Results. After a median follow-up of 60 months, 25 patients (68 %) in the study group are alive. Deaths occurred in 10 patients (29 %), of which 9 (26 %) were due to disease progression, and 1 (3 %) was due to complications of the treatment. One patient (3 %) was lost to follow-up.

Conclusions. The expanded use of transnasal endoscopic surgery in the treatment of children with parameningeal rhabdomyosarcoma is driven by a unique combination of advantages: excellent intraoperative visualization, ensuring radical intervention, and minimal trauma, preserving intact anatomical structures. Further development of this technique, in turn, is stimulated by technological innovations and close interdisciplinary collaboration.

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