Endoscopic Endonasal Transsphenoidal Approach for Sellar and Perisellar Lesions in Children: Interdisciplinary Experiences

• Published in: Skull Base Vol. 19; no. 1
• Main Author: Gellner, Verena
• Format: Conference Proceeding Journal Article
• Language: English
• Published: 14.04.2009
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2009-1222205

Purpose: To evaluate the surgical results of endoscopic transsphenoidal approaches for sellar region tumors in children. Methods: From 2003 to 2008, 12 children with intra- and/or extrasellar lesions were treated by 15 endoscopic image-guided transsphenoidal approaches by a multidisciplinary team. The mean age was 13.7 years (range, 4–18 years); 58.3% were female. Visual field deficiency was present in 4 children. Results: Mean follow-up was 20.5 months (range, 0–50 months); 1 patient was lost to follow-up. Histological diagnosis disclosed pituitary adenoma in 5 children; 2 had craniopharyngioma; and 5 patients had other pathologies such as Rathke cleft cyst, PNET, low-grade astrocytoma, schwannoma, and osteoma. Total removal was achieved in 6 cases, subtotal removal in 3, partial removal in 5, and biopsy was the aim of surgery in 2 children. Postoperative complications comprising cerebrospinal fluid rhinorrhea and transient diabetes insipidus (DI) occurred in 33.3%( n  = 4); only 1 child showed permanent DI. Further treatment consisted of 3 endoscopic reoperations, 2 craniotomies, and 3 radiosurgical procedures due to residual or recurrent tumors. Visual field normalized in 3 children; in 1 it remained stable. Conclusion: The endoscopic transsphenoidal approach has shown to be applicable for a wide variety of intra- and extrasellar lesions. The procedure is minimally invasive compared with the inflicting alternative transcranial procedures and can be regarded as safe with very satisfying results even in children.