Suprasellar and Recurrent Pediatric Craniopharyngiomas: Expanding Indications for the Extended Endoscopic Transsphenoidal Approach

Alalade, Andrew F.; Ogando‐Rivas, Elizabeth; Boatey, Jerome; Souweidane, Mark M.; Anand, Vijay K.; Greenfield, Jeffrey; Schwartz, Theodore H.

doi:10.1055/s-0038-1633669

Cited by 19 publications

(45 citation statements)

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“…Transnasal endoscopic approaches in children have mostly been reported as part of larger adult-inclusive series 5,10,12,23 or as case reports, 16,18,32,33,36 but they have increasingly been described in the resection of pediatric skull base lesions. 2,4,6,9,17,30,34,40,41 Our pediatric series presents a tertiary care center's experience of implementing this surgical approach for a diverse group of sellar and suprasellar pathologies (a total of 9 different indications). Previous reports of a similar nature have been published but were either smaller in sample size 2,4,11,17,34 or conducted in a different country.…”

Section: Discussionmentioning

confidence: 99%

Transnasal endoscopic approach for pediatric skull base lesions: a case series

Quon¹,

Kim²,

Hwang

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVETransnasal endoscopic transsphenoidal approaches constitute an essential technique for the resection of skull base tumors in adults. However, in the pediatric population, sellar and suprasellar lesions have historically been treated by craniotomy. Transnasal endoscopic approaches are less invasive and thus may be preferable to craniotomy, especially in children. In this case series, the authors present their institutional experience with transnasal endoscopic transsphenoidal approaches for pediatric skull base tumors.METHODSThe authors retrospectively reviewed pediatric patients (age ≤ 18 years) who had undergone transnasal endoscopic transsphenoidal approaches for either biopsy or resection of sellar or suprasellar lesions between 2007 and 2016. All operations were performed jointly by a team of pediatric neurosurgeons and skull base otolaryngologists, except for 8 cases performed by one neurosurgeon.RESULTSThe series included 42 patients between 4 and 18 years old (average 12.5 years) who underwent 51 operations. Headache (45%), visual symptoms (69%), and symptoms related to hormonal abnormalities (71%) were the predominant presenting symptoms. Improvement in preoperative symptoms was seen in 92% of cases. Most patients had craniopharyngiomas (n = 16), followed by pituitary adenomas (n = 12), Rathke cleft cysts (n = 4), germinomas (n = 4), chordomas (n = 2), and other lesion subtypes (n = 4). Lesions ranged from 0.3 to 6.2 cm (median 2.5 cm) in their greatest dimension. Gross-total resection was primarily performed (63% of cases), with 5 subsequent recurrences. Nasoseptal flaps were used in 47% of cases, fat grafts in 37%, and lumbar drains in 47%. CSF space was entered intraoperatively in 15 cases, and postoperative CSF was observed only in lesions with suprasellar extension. There were 8 cases of new hormonal deficits and 3 cases of new cranial nerve deficits. Length of hospital stay ranged from 1 to 61 days (median 5 days). Patients were clinically followed up for a median of 46 months (range 1–120 months), accompanied by a median radiological follow-up period of 45 months (range 3.8–120 months). Most patients (76%) were offered adjuvant therapy.CONCLUSIONSIn this single-institution report of the transnasal endoscopic transsphenoidal approach, the authors demonstrated that this technique is generally safe and effective for different types of pediatric skull base lesions. Favorable effects of surgery were sustained during a follow-up period of 4 years. Further refinement in technology will allow for more widespread use in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Transnasal endoscopic approach for pediatric skull base lesions: a case series

Quon¹,

Kim²,

Hwang

et al. 2019

Journal of Neurosurgery: Pediatrics

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“…Incidence of CSF leak varies widely (0%‐23%) . While the strongest risk factor for postoperative CSF leak is intraoperative CSF leak, the rate of leak is variable and also dependent on the pathology being managed as well as the volume, complexity, and experience of the surgeon .…”

Section: Complicationsmentioning

confidence: 99%

The expanded endonasal approach in pediatric skull base surgery: A review

London

Rangel

Walz

2020

Laryngoscope Investig Oto

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Objective: Surgery of the pediatric skull base has multiple unique challenges and has seen recent rapid advances. The objective of this review is to assess key issues in pediatric skull base surgery (SBS), including anatomic limitations, surgical approaches, reconstruction techniques, postoperative care, complications, and outcomes.Data Sources: PubMed literature review.Review Methods: A review of the literature was conducted to assess the challenges, recent advances, and reported outcomes in pediatric SBS.Results: The pediatric skull base presents multiple anatomic challenges, including variable patterns of pneumatization, narrow piriform aperture width, and narrow intercarotid distance at the level of the cavernous sinus but not the superior clivus. These issues may be particularly challenging in patients less than 2 years of age. Endoscopic endonasal approaches in the sagittal and coronal plane have been applied to the pediatric skull base while open approaches may still be necessary in the setting of extensive intracranial or orbital disease, as well as disease lateral to critical neurovascular structures. While the nasoseptal flap was initially called into question for pediatric cases, it has been shown through multiple reports to be a feasible and robust reconstructive option. Complications and outcomes often depend upon the pathology. In children, response to noxious stimuli, ability to avoid Valsalva, and adherence to nasal precautions is variable. The use of lumbar drains is more common in pediatric than adult patients.Conclusion: While the pediatric skull base presents unique challenges, outcomes data support that endoscopic endonasal approaches are a pertinent surgical technique in appropriately selected patients. Level of Evidence: 3aK E Y W O R D S endoscopic endonasal approach, pediatric skull base surgery, skull base reconstruction, surgical outcomes

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“…CPs have been classically claimed to represent a suprasellar, extra-axial type of epithelial lesion. Unfortunately, the term "suprasellar" remains invariably linked to the concept of CPs, and it still dominates the neurosurgical and neuroradiological literature on these tumors [20,27,28]. The widespread use of the term "suprasellar" for CPs dates back to the early 20 th Century, when the identification of dense shadows above the sella turcica represented the major radiological sign to ascertain the preoperative diagnosis of these lesions [25,26].…”

Section: Craniopharyngioma: Not a Suprasellar But A True Hypothalamicmentioning

confidence: 99%

Craniopharyngiomas: An Appropriate Surgical Treatment based on Topographical and Pathological Concepts

Prieto¹,

Pascual²

2018

obm neurobiol

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The optimal treatment of craniopharyngiomas (CPs) represents a neurosurgical challenge, the major reason being their close relationship with the hypothalamus and the third ventricle (3V) boundaries. Nevertheless, CPs are generally defined as "suprasellar" lesions, an inexplicit and frequently defective term. Despite being heterogeneous lesions, CPs are actually characterized by repeating pathological patterns which depend on their point of origin along the pituitary-hypothalamic axis. Surgical plan in tailoring the best treatment strategy needs to take in consideration some critical aspects, including the understanding of the accurate CP-hypothalamus relation. Without firm consensus and proposed guidelines for the appropriated management of CPs, radical removal and conservative resection remain the two opposing therapeutic strategies. However, an increasing leading of opinions stress out these two strategies should be replaced by a tailored plan to pursue the maximal tumor resection while minimizing the likelihood of hypothalamic injury in each case. Based on the

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Suprasellar and Recurrent Pediatric Craniopharyngiomas: Expanding Indications for the Extended Endoscopic Transsphenoidal Approach

Cited by 19 publications

References 0 publications

Transnasal endoscopic approach for pediatric skull base lesions: a case series

Transnasal endoscopic approach for pediatric skull base lesions: a case series

The expanded endonasal approach in pediatric skull base surgery: A review

Craniopharyngiomas: An Appropriate Surgical Treatment based on Topographical and Pathological Concepts

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