Endoscopic endonasal transsphenoidal surgery for sellar tumors in children

Locatelli, Davide; Massimi, Luca; Rigante, Mario; Custodi, Viola Marta; Paludetti, Gaetano; Castelnuovo, Paolo; Rocco, Concezio Di

doi:10.1016/j.ijporl.2010.08.009

Cited by 70 publications

(81 citation statements)

References 31 publications

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“…Narrow sinonasal pathways and lack of instruments dedicated to pediatric patients are possible limitations of transsphenoidal surgery [21]. Although we never use the ‘two-nostrils-four-hands' technique, Locatelli et al [21] pointed out that involvement of both nostrils does not increase the risk of nasal morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Although we never use the ‘two-nostrils-four-hands' technique, Locatelli et al [21] pointed out that involvement of both nostrils does not increase the risk of nasal morbidity. We think that the transnasal pathway with small-diameter pediatric speculums is sufficient for satisfactory resection of adenomas.…”

Section: Discussionmentioning

confidence: 99%

“…The pneumatization of the sphenoid sinus is believed to start from the 3rd to 4th year of age and to be completed in the second decade of life [21]. In contrast, some anatomical and radiological studies demonstrated that sphenoid pneumatization begins during the first months of age and is usually completed within the first decade [22,23,24].…”

Section: Discussionmentioning

confidence: 99%

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Transnasal Transsphenoidal Surgical Method in Pediatric Pituitary Adenomas

Taşkapılıoğlu¹,

Yılmazlar²,

Eren

et al. 2015

Pediatr Neurosurg

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Aim: To evaluate the clinical outcome in a 13-year consecutive series of children operated for pituitary adenomas with transnasal transsphenoidal surgery. Methods: All patients <18 years who were operated on at our center by transsphenoidal surgery for pediatric pituitary adenomas were included in the study. Clinical features, hormonal profile, radiology, surgical approach, results and complications were analyzed. Results: Eighteen patients (90%) had functional pituitary adenomas and 2 (10%) patients had nonfunctional pituitary adenoma. The most common type was prolactin-secreting adenoma (n = 12), followed by corticotropinoma (n = 4), growth hormone-secreting adenoma (n = 2), and nonfunctioning adenoma (n = 2). Prolactin-secreting adenomas in children occurred more commonly with suprasellar expansion than did other adenomas. Conclusion: Transsphenoidal surgery was effective for decompression of suprasellar extension and relieved the chiasmal compression immediately. Prolactin-secreting tumors required postoperative medical therapy for persistently elevated prolactin levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transnasal Transsphenoidal Surgical Method in Pediatric Pituitary Adenomas

Taşkapılıoğlu¹,

Yılmazlar²,

Eren

et al. 2015

Pediatr Neurosurg

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“…These data may reflect the limited morbidity offered by the endoscopic approach due to allowing for a more direct approach to the lesion, with less manipulation of surrounding neurovascular structures to access the tumor, early decompression of the optic tract, as well as improved reconstructive techniques limiting the incidence of postoperative CSF leaks. 30,51,59,62 We cannot exclude that the positive QALYs identified may be subject to the selection bias of limiting this approach to those tumors that are primarily intrasellar and of small size. As optics, video equipment, and endoscopic surgical instrumentation all continue to improve, one can predict that transsphenoidal endoscopic approaches to craniopharyngiomas may facilitate a high rate of endocrine function preservation and visual improvement, while concurrently achieving comparable resections 30 and, consequently, improving QALYs, even compared with biopsy and radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

Ali

Bailey

Daniels

et al. 2014

PED

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Object No clear treatment guidelines for pediatric craniopharyngiomas exist. The authors developed a decision analytical model to evaluate outcomes of 4 surgical approaches for craniopharyngiomas in children, including attempted gross-total resection (GTR), planned subtotal removal plus radiotherapy, biopsy plus radiotherapy, and endoscopic resections of all kinds. Methods Pooled data, including the authors' own experience, were used to create evidence tables, from which incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) were calculated for the 4 management strategies. Results Quality-adjusted life years at the 5-year follow-up were 2.3 ± 0.1 for attempted GTR, 2.9 ± 0.2 for planned subtotal removal plus radiotherapy, 3.9 ± 0.2 for biopsy plus radiotherapy, and 3.7 ± 0.2 for endoscopic resection (F = 17,150, p < 0.001). Similarly, QALYs at 10-year follow-up were 4.5 ± 0.2 for attempted GTR, 5.7 ± 0.5 for planned subtotal removal plus radiotherapy, and 7.8 ± 0.5 for biopsy plus radiotherapy (F = 6,173, p < 0.001). On post hoc pairwise comparisons, the differences between all pairs compared were also highly significant (p < 0.001). Since follow-up data at 10 years are lacking for endoscopic cases, this category was excluded from 10-year comparisons. Conclusions Biopsy with subsequent radiotherapy is the preferred approach with respect to improved overall quality of life. While endoscopic approaches also show promise in preserving quality of life at five-year follow-up, there are not sufficient data to draw conclusions about this comparison at 10 years.

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“…Feasibility of these approaches in children has been demonstrated. 4,8,9 However, successful EEA surgery requires an adequate working space for the endoscope as well as the instruments. Hesitations and questions have been raised regarding the feasibility of performing EEAs in pediatric patients, given the smaller working space compared with adults.…”

Section: 19mentioning

confidence: 99%

Impact of skull base development on endonasal endoscopic surgical corridors

Banu

Guerrero-Maldonado

McCrea

et al. 2014

PED

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Object Scarce morphometric data exist on the developing skull base as a corridor for endonasal endoscopic approaches (EEAs). Furthermore, the impact of skull base lesions on its development has not been assessed. The authors describe a novel set of anatomical parameters characterizing the developmental process as well as the utility of these parameters in preoperative planning and a feasibility assessment of EEAs for neurosurgical treatment of skull base lesions in children. Methods Based on specific MRI sequences in 107 pediatric patients (2–16 years of age) without skull base lesions (referred to here as the normal population), 3 sets of anatomical parameters were analyzed according to age group and sex: drilling distance, restriction sites, and working distance parameters. A separate set of patients undergoing EEAs was analyzed in similar fashion to address the impact of skull base lesions on the developmental process. Results The volume of the sphenoid sinus significantly increases with age, reaching 6866.4 mm3 in the 14–16 years age group, and directly correlates with the pneumatization type (r = 0.533, p = 0.0001). The pneumatization process progresses slowly in a temporal-posterior direction, as demonstrated by the growth trend of the sellar width (r = 0.428, p = 0.0001). Nasal restriction sites do not change significantly with age, with little impact on EEAs. The intercarotid distance is significantly different only in the extreme age groups (3.9 mm, p = 0.038), and has an important impact on the transsphenoidal angle and the intracranial dissection limits (r = 0.443, p < 0.0001). The 14.9° transsphenoidal angle at 2–4 years has a 37.6% significant increase in the 11–13 years age group (p = 0.001) and is highly dependent on pneumatization type. Age-dependent differences between working parameters are mostly noted for the extreme age groups, such as the 8.6-mm increase in nare-vomer distance (p = 0.025). The nare-sellar distance is the only parameter with significant differences based on sex. Skull base lesions induce a high degree of variance in skull base measurements, delaying development and decreasing parameter values. Skull base parameters are interdependent. Nare-sellar distance can be used to assess global skull base development because it highly correlates with the intercarotid distance in both the normal population and in patients harboring skull base lesions. Conclusions Skull base development is a slow, gradual, age-dependent, sex-independent process significantly altering endonasal endoscopic corridors. Preoperative MRI measurements of the pediatric skull base are thus a useful adjunct in choosing the appropriate corridor and in assessing working angles and limits during dissection or reparative surgery. Skull base lesions can significantly impact normal skull base development and age-dependent growth patterns.

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Endoscopic endonasal transsphenoidal surgery for sellar tumors in children

Cited by 70 publications

References 31 publications

Transnasal Transsphenoidal Surgical Method in Pediatric Pituitary Adenomas

Transnasal Transsphenoidal Surgical Method in Pediatric Pituitary Adenomas

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

Impact of skull base development on endonasal endoscopic surgical corridors

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