Abstract
Purpose
The endoscopic endonasal approach (EEA) is a credible surgical alternative for the resection of sellar and suprasellar lesions such as pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts. However, its application to pediatric patients poses several unique challenges that have not yet been well evaluated. The authors evaluate the safety, efficacy, and outcomes associated with the use of the EEA for treatment of these pathologic entities in pediatric patients.
Methods
Retrospective review of 30 patients between the ages of two and 24 who underwent endoscopic endonasal resection of sellar or suprasellar lesions between January 2010 and December 2015. Endocrinological and ophthalmological outcomes, as well as extent of resection and complications were all evaluated.
Results
Gross total resection was achieved in eight of the nine pituitary adenomas, nine of the 12 craniopharyngiomas, and six of the nine Rathke cleft cysts. Of the 30 patients, 22 remained disease free at last follow-up. A total of six patients developed hypopituitarism and five developed diabetes insipidus. Eleven patients experienced improved vision, sixteen experienced no change, and one patient experienced visual worsening. Postoperative cerebrospinal fluid leak was seen in a single case and later resolved, vasospasm/stroke was experienced by 10% of patients, and new obesity was recorded in 10% of patients. There were no perioperative deaths.
Conclusions
Endoscopic endonasal resection is a safe and effective surgical alternative for the management of sellar and suprasellar pathologies in pediatric populations with excellent outcomes, minimal complications, and a low risk of morbidity.
Similar content being viewed by others
References
Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH (2005) Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 102:189–193
Benveniste RJ, King WA, Walsh J, Lee JS, Naidich TP, Post KD (2004) Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg 101:577–584
Brockmeyer D, Gruber DP, Haller J, Shelton C, Walker ML (2003) Pediatric skull base surgery. 2. Experience and outcomes in 55 patients. Pediatr Neurosurg 38:9–15
Campbell PG, McGettigan B, Luginbuhl A, Yadla S, Rosen M, Evans JJ (2010) Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas. Neurosurg Focus 28:E8
Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, del Basso de Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45:193–200
Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P et al (2005) Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 19:E2
Cavallo LM, Prevedello DM, Solari D, Gardner PA, Esposito F, Snyderman CH, Carrau RL, Kassam AB, Cappabianca P (2009) Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. J Neurosurg 111:578–589
Chakrabarti I, Amar AP, Couldwell W, Weiss MH (2005) Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg 102:650–657
Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC (2013) Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11:227–241
Conger AR, Lucas J, Zada G, Schwartz TH, Cohen-Gadol AA (2014) Endoscopic extended transsphenoidal resection of craniopharyngiomas: nuances of neurosurgical technique. Neurosurg Focus 37:E10
de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A (2007) Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 61:219–227 discussion 228
Dehdashti AR, Ganna A, Witterick I, Gentili F (2009) Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery 64:677–687 discussion 687-679
Deschler DG, Gutin PH, Mamelak AN, McDermott MW, Kaplan MJ (1996) Complications of anterior skull base surgery. Skull Base Surg 6:113–118
Di Rocco C, Caldarelli M, Tamburrini G, Massimi L (2006) Surgical management of craniopharyngiomas--experience with a pediatric series. J Pediatr Endocrinol Metab 19(Suppl 1):355–366
Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250
Fatemi N, Dusick JR, de Paiva Neto MA, Kelly DF (2008) The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10-year experience. Neurosurgery 63:244–256 discussion 256
Feiz-Erfan I, Han PP, Spetzler RF, Horn EM, Klopfenstein JD, Porter RW, Ferreira MAT, Beals SP, Lettieri SC, Joganic EF (2005) The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg 103:485–490
Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G et al (2006) The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 59:ONS75–ONS83 discussion ONS75-83
Gandhi CD, Christiano LD, Eloy JA, Prestigiacomo CJ, Post KD (2009) The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus 27:E8
Gardner PA, Kassam AB, Snyderman CH, Carrau RL, Mintz AH, Grahovac S, Stefko S (2008) Outcomes following endoscopic, expanded endonasal resection of suprasellar craniopharyngiomas: a case series. J Neurosurg 109:6–16
Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882–1886
Honegger J, Buchfelder M, Fahlbusch R (1999) Surgical treatment of craniopharyngiomas: endocrinological results. J Neurosurg 90:251–257
Honegger J, Buchfelder M, Fahlbusch R, Daubler B, Dorr HG (1992) Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol 37:189–196
Karavitaki N, Brufani C, Warner JT, Adams CB, Richards P, Ansorge O et al (2005) Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol 62:397–409
Kassam A, Thomas AJ, Snyderman C, Carrau R, Gardner P, Mintz A, Kanaan H, Horowitz M, Pollack IF (2007) Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 106:75–86
Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D et al (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63:ONS44–ONS52 discussion ONS52-43
Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH (2013) Endoscopic endonasal surgery for craniopharyngiomas: surgical outcome in 64 patients. J Neurosurg 119:1194–1207
Laufer I, Anand VK, Schwartz TH (2007) Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106:400–406
Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH (2012) Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery 70:110–123 discussion 123-114
Lobo B, Heng A, Barkhoudarian G, Griffiths CF, Kelly DF (2015) The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: a 2014 perspective. Surg Neurol Int 6:82
Locatelli D, Rampa F, Acchiardi I, Bignami M, Pistochini A, Castelnuovo P (2006) Endoscopic endonasal approaches to anterior skull base defects in pediatric patients. Childs Nerv Syst 22:1411–1418
Lustig RH, Post SR, Srivannaboon K, Rose SR, Danish RK, Burghen GA, Xiong X, Wu S, Merchant TE (2003) Risk factors for the development of obesity in children surviving brain tumors. J Clin Endocrinol Metab 88:611–616
Pinto G, Bussieres L, Recasens C, Souberbielle JC, Zerah M, Brauner R (2000) Hormonal factors influencing weight and growth pattern in craniopharyngioma. Horm Res 53:163–169
Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK (2008) Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 62:991–1002 discussion 1002-1005
Shi XE, Wu B, Zhou ZQ, Fan T, Zhang YL (2006) Microsurgical treatment of craniopharyngiomas: report of 284 patients. Chin Med J 119:1653–1663
Sklar CA (1994) Craniopharyngioma: endocrine sequelae of treatment. Pediatr Neurosurg 21(Suppl 1):120–123
Solari D, Cavallo LM, Somma T, Chiaramonte C, Esposito F, Del Basso De Caro M et al (2015) Endoscopic endonasal approach in the management of Rathke’s cleft cysts. PLoS One 10:e0139609
Sorva R (1988) Children with craniopharyngioma. Early growth failure and rapid postoperative weight gain. Acta Paediatr Scand 77:587–592
Stahnke N, Grubel G, Lagenstein I, Willig RP (1984) Long-term follow-up of children with craniopharyngioma. Eur J Pediatr 142:179–185
Stamm AC, Vellutini E, Harvey RJ, Nogeira JF Jr, Herman DR (2008) Endoscopic transnasal craniotomy and the resection of craniopharyngioma. Laryngoscope 118:1142–1148
Van Effenterre R, Boch AL (2002) Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97:3–11
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Koumas, C., Laibangyang, A., Barron, S.L. et al. Outcomes following endoscopic endonasal resection of sellar and supresellar lesions in pediatric patients. Childs Nerv Syst 35, 2099–2105 (2019). https://doi.org/10.1007/s00381-019-04258-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-019-04258-1