2022 Volume 47 Issue 1 Pages 7-17
Objective: Extended endoscopic endonasal transsphenoidal surgery (Ext-EETS) is increasingly being applied for suprasellar tumors, including craniopharyngiomas in pediatric populations, along with advances in neuroendoscopic instruments and techniques. In pediatric patients, there are some clinical and anatomical problems that should be noted. These include limited working space in the narrow nasal cavity, ossification of the sphenoid sinus (conchal or pre-sellar type), intolerance to damaged endocrinological functions and vascular injury in the hypothalamic and pituitary areas, and difficulty in surgical techniques for skull base reconstruction. In this study, we reviewed our series of pediatric cases of Ext-EETS and investigated the advantages and problems of this approach.
Patients and Methods: We retrospectively identified 29 patients (5.0%) who underwent Ext-EETS at our institute between January 2006 and December 2020 in our series of 588 patients who underwent EETS. This was a single-center study of 12 patients aged 18 years or younger, including eight males and four females between the ages of 1 to 18 years (mean age, 11.8±5.0 years). They harbored suprasellar tumors and were treated with Ext-EETS: 10 of those with craniopharyngioma, and each one of those with germinoma and prolactinoma. The patients were evaluated in terms of age, preoperative symptoms, whether the masses were cystic or solid, tumor location, degree of tumor removal, previous surgeries, radiation therapy, hormonal replacement, duration of follow-up, and academic status from their clinical charts.
Results: Symptoms were present in all cases except one; 11 had visual disturbances, one had polyuria, and one had headache. Ten of them had cystic masses, and two of them had solid masses. The locations of the cranipharyngioma were purely suprasellar in nine cases and there were suprasellar extension in three cases. Grossly total removal was performed in five cases, subtotal in three, partial in three, and biopsy in one. A previous craniotomy was performed in three cases, and reoperation after EETS was performed in one case. Seven patients with craniopharyngiomas underwent radiation therapy after Ext-EETS. Hormonal replacement was performed in all cases except one. The follow-up period ranged from 1 to 17 years.
Conclusion: We believe that this Ext-EETS is useful for pediatric suprasellar tumors based on the results of this preliminary study. Further advancement of endoscopic instruments and surgical techniques is required to obtain excellent outcomes in larger studies.
