Christoforos Koumas1, Anya Laibangyang1, Shanna L Barron2, Mark A Mittler1,2, Steven J Schneider1,2, Shaun D Rodgers3,4. 1. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA. 2. Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA. 3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA. srodgers@northwell.edu. 4. Division of Pediatric Neurosurgery, Cohen Children's Medical Center, 410 Lakeville Road, Suite 204, New Hyde Park, NY, 11042, USA. srodgers@northwell.edu.
Abstract
PURPOSE: The endoscopic endonasal approach (EEA) is a credible surgical alternative for the resection of sellar and suprasellar lesions such as pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts. However, its application to pediatric patients poses several unique challenges that have not yet been well evaluated. The authors evaluate the safety, efficacy, and outcomes associated with the use of the EEA for treatment of these pathologic entities in pediatric patients. METHODS: Retrospective review of 30 patients between the ages of two and 24 who underwent endoscopic endonasal resection of sellar or suprasellar lesions between January 2010 and December 2015. Endocrinological and ophthalmological outcomes, as well as extent of resection and complications were all evaluated. RESULTS: Gross total resection was achieved in eight of the nine pituitary adenomas, nine of the 12 craniopharyngiomas, and six of the nine Rathke cleft cysts. Of the 30 patients, 22 remained disease free at last follow-up. A total of six patients developed hypopituitarism and five developed diabetes insipidus. Eleven patients experienced improved vision, sixteen experienced no change, and one patient experienced visual worsening. Postoperative cerebrospinal fluid leak was seen in a single case and later resolved, vasospasm/stroke was experienced by 10% of patients, and new obesity was recorded in 10% of patients. There were no perioperative deaths. CONCLUSIONS: Endoscopic endonasal resection is a safe and effective surgical alternative for the management of sellar and suprasellar pathologies in pediatric populations with excellent outcomes, minimal complications, and a low risk of morbidity.
PURPOSE: The endoscopic endonasal approach (EEA) is a credible surgical alternative for the resection of sellar and suprasellar lesions such as pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts. However, its application to pediatric patients poses several unique challenges that have not yet been well evaluated. The authors evaluate the safety, efficacy, and outcomes associated with the use of the EEA for treatment of these pathologic entities in pediatric patients. METHODS: Retrospective review of 30 patients between the ages of two and 24 who underwent endoscopic endonasal resection of sellar or suprasellar lesions between January 2010 and December 2015. Endocrinological and ophthalmological outcomes, as well as extent of resection and complications were all evaluated. RESULTS: Gross total resection was achieved in eight of the nine pituitary adenomas, nine of the 12 craniopharyngiomas, and six of the nine Rathke cleft cysts. Of the 30 patients, 22 remained disease free at last follow-up. A total of six patients developed hypopituitarism and five developed diabetes insipidus. Eleven patients experienced improved vision, sixteen experienced no change, and one patient experienced visual worsening. Postoperative cerebrospinal fluid leak was seen in a single case and later resolved, vasospasm/stroke was experienced by 10% of patients, and new obesity was recorded in 10% of patients. There were no perioperative deaths. CONCLUSIONS: Endoscopic endonasal resection is a safe and effective surgical alternative for the management of sellar and suprasellar pathologies in pediatric populations with excellent outcomes, minimal complications, and a low risk of morbidity.
Authors: Taylor R Carle; Vivian Wung; Anthony P Heaney; Harvey K Chiu; Jeffrey D Suh; Marvin Bergsneider; Marilene B Wang Journal: J Neurol Surg B Skull Base Date: 2021-05-17
Authors: Alexander P Kelly; Jeffrey P Greenfield; Georgiana A Dobri; Theodore H Schwartz Journal: Childs Nerv Syst Date: 2022-01-19 Impact factor: 1.475