Background Surgery is often indicated for definitive biopsy or as the primary treatment modality for pediatric skull base lesions. Traditionally, open surgical approaches were utilized to address pediatric skull base pathology. However recently, expanded endoscopic sinus surgery has been utilized as a minimally invasive approach to addressing skull base pathology in the pediatric population. Purpose This review provides an overview of the current literature evaluating the unique anatomic

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... ges of the pediatric skull and the safety and efficacy of expanded skull base procedures in the pediatric population. Findings The pediatric skull base and sinus anatomy is small and continues to develop throughout childhood leading to unique surgical challenges. Sphenoid sinus pneumatization and intercarotid distance at the skull base are two significant anatomic challenges to pediatric skull base surgery. Despite the distinctive anatomy challenges, recent studies demonstrate that the safety and efficacy of expanded endoscopic sinus surgery appear to be equivalent to traditional open surgical approaches. Conclusion Expanded endoscopic sinus surgery in the pediatric population has similar efficacy and safety as the traditional open approaches.