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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Transnasal 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In 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.</jats:p></jats:sec>

Visual functions in children with craniopharyngioma at diagnosis: A systematic review

“…Twenty-nine studies described decreased VA in one or both eyes without giving any further details about the degree of VA reduction in 365 of 831 children (43.9%). Visual loss was found in 31 of 68 children (45.6%) [ 39 , 43 , 57 , 86 , 104 ]. Blindness in one or two eyes with or without PL was present in 71 of 515 children with CP (13.8%) [ 10 , 14 , 24 , 61 , 77 , 89 , 96 , 99 , 101 , 103 , 104 , 106 ].…”

“…Blindness in one or two eyes with or without PL was present in 71 of 515 children with CP (13.8%) [ 10 , 14 , 24 , 61 , 77 , 89 , 96 , 99 , 101 , 103 , 104 , 106 ]. Ali (2013) [ 54 ] and Quon (2019) [ 57 ] described blurry vision in 3 of 23 patients (13.0%). Loss of central VA was reported in 12 of 18 children by Chamlin (1955) [ 52 ].…”

“…The remaining studies reported the type of the VF defect in detail. Bitemporal hemianopia was reported in 98 of 332 patients (29.5%) with pertinent data [ 6 , 9 , 25 , 31 , 38 , 48 , 52 , 57 , 61 , 71 , 72 , 80 , 84 , 86 , 89 , 91 , 94 , 96 , 99 , 102 , 105 , 107 , 109 ]. Twenty-three of 177 children (13.0%) were diagnosed with an unitemporal hemianopia [ 6 , 25 , 53 , 61 , 84 , 94 , 96 , 102 , 105 ].…”

“…Intraventricular CP was reported in 49 children (2.6%). Quon (2009) [57] reported 15 CP with suprasellar extension and one CP without tumour location. Seven patients had a suprasellar extraventricular CP [92].…”

“…Weiss (1989) reported about asymptomatic papilledema or optic atrophy in 5 of 31 patients (16.1%) [59]. Optic nerve compression was found in 1 of 16 patients (6.25%) by Quon (2019) [57]. Al-Mefty (1985) reported about the presence of the Foster-Kennedy syndrome in 3 of 15 patients (20%) [99].…”