Endoscopic endonasal transsphenoidal surgery for sellar tumors in children

OBJECTIVE: Endoscopic endonasal transsphenoidal surgery (EETS) is still rarely
used in pediatric subjects compared with adults. Reports on EETS in children
appeared only recently in the literature, usually regarding small series. The aim
of the study is to assess the actual role and the limits of EETS in children with
sellar tumors by reporting a two-centers experience.
METHODS: Twenty-seven children (mean age: 12.2 years) were operated on during the
last decade. Seventeen patients harbored a sellar mass, 7 a suprasellar tumor,
and 3 a clival mass. Laboratory investigations revealed hypopituitarism in 6
children and hormone hypersecretion in 9. All the operations were carried out by
a team including both ENT surgeon and neurosurgeon using a dedicated 18-cm long
rigid endoscope (2.7 mm and 4 mm diameter) through the direct paraseptal or the
transethmoidal or the transpterygoid route.
RESULTS: Overall, 29 operations were performed. Gross total tumor resection was
obtained in 22 children (81.5%) while a subtotal and a partial removal in 2
(7.5%) and 3 cases (11%), respectively. Pituitary adenoma was the most common
histotype (12 cases), followed by craniopharyngioma (5) and Rathke's cleft cyst
(4). No surgical mortality or neurological morbidity or late nasal complications
were observed. Postoperative CSF fistula occurred in 3 patients. All children are
alive at current follow-up (average: 8.6 years). Preoperative hypopituitarism
disappeared or improved in 4 cases and was stable in the remaining 2 (no new
hormone deficits appeared).
CONCLUSION: EETS is a safe and effective surgical option also in children. As for
adults, it allows to manage most of the tumor lesions of the sellar region with
stable long-term results.