Abstract
Transnasal surgery has been performed in only a small number of cases of childhood craniopharyngiomas, and its efficacy is still a matter of debate. We analyzed the results of primary transnasal surgery in 9 children (4 boys and 5 girls) with infradiaphragmatic craniopharyngiomas under 15 years of age at surgery (7.7-14.9 yr) and who were treated between 1985 and 1996, when more refined surgical and diagnostic techniques were available. The transnasal approach was chosen because of sellar enlargement and the presence of an infradiaphragmatic tumor. The duration of the clinical follow-up period was at least 1 year. Five children required drilling of incompletely pneumatized sphenoid sinuses to reach the sella, but in no cases were the anatomic differences related to patient age or size thought to be a limiting factor in the transnasal procedure. The normal pituitary gland was incised to expose a dorsally located tumor in each of seven children (77.8%) . This surgical procedure has never provoked any major functional damage to the anterior pituitary gland. Complete tumor resection was achieved in three children and subtotal removal in six. Persistent diabetes insipidus occurred after total tumor resection in one child. Gamma knife was performed in one patient with tumor regrowth. Based on the present findings, transnasal surgery seemes to be indicated for most of inf radiaphragmatic craniopharyngiomas in children. The concept of subtotal tumor removal with preservation of pituitary function, avoiding damage to hypothalamic structures and excessive cerebrospinal fluid leakage, seems to be justified in children.
