Abstract
Background: Pathology along the anterior and posterior skull base has long posed challenges to surgeons due to the difficulty accessing these locations and complexity of the surrounding neurovascular anatomy. Initial surgical management of these disorders included open craniofacial approaches and craniotomy, and these approaches are still utilized today for selected cases. However, advances in the latter half of the 20th century
in optics, endoscope design, and high definition digital images allowed the development of microscopic and, more recently, endoscopic approaches to the skull base. This technology was initially developed and used in adults but has been adapted over time for use in the pediatric patient.
Objectives: Assess the prevalence of pediatric endoscopic sinus surgery (ESS) and skull-base surgery and evaluation of its role in clinical practice. Patients and Methods: This study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 60 patients who subjected to ESS were included in this study. Data was then transferred to the Statistical Package of Social Science Software program, version 23 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY) to be statistically analyzed.
Results: The data of 60 children were obtained from King Fahd Specialized Hospital-Dammam data base. They were classified into five groups according to the type of surgery. Most of the patients (36.7%) suffered from allergic fungal sinusitis (AFS). Their ages ranged from 0.1 to 17 years old with the Mean ± SD of 8.8 ± 5.4 years and a median of 10 years. About half of them (46.7%) were more than 10-year old. More than half of them (51.7%) were males. Most of them (60%) subjected to Functional ESS. 21.7% were diagnosed with Fungal Sinusitis and 20% diagnosed with 20% Choanal Atresia.
Conclusion: The ESS is an effective way to control many different conditions, including chronic rhinosinusitis, cerebrospinal fluid Rhinorrhea, AFS, Tumors, and Choanal atresia among children population.

Key words: Pediatric, endoscopic sinus surgery (ESS), allergic fungal sinusitis (AFS), King Fahd Specialized Hospital (KFSH).