Endoscopic endonasal transsphenoidal surgery in children: widening the spectrum of oncological indications in the pediatric age group

Endoscopic endonasal transsphenoidal surgery (EETS) is increasingly used in children to treat skull base lesions. The aim of this study is to present our updated institutional experience.

A retrospective analysis of all pediatric patients (≤18 years old) treated via EETS for skull base pathologies at our institution, between January 2006 and December 2022, was carried out.

Sixty-seven children (mean age: 11.4 years) were operated on. Overall, 85 procedures were performed, including tumor residuals/recurrences after a previous craniotomy approach (11). Considering the planned goal of surgery, GTR was achieved in 73% of the cases, while STR and PR in 100% of the cases. Pituitary adenoma was the most common histotype (20), followed by craniopharyngioma (19), chordoma and sarcoma (8), optic pathway/hypothalamic glioma (5), Rathke cleft cyst (4), germ cell tumor (3), fibrous dysplasia (3), and angiofibroma (2). After surgery, most patients experienced improvement or stability of the preoperative symptoms. No surgical mortality or late nasal and facial complications were observed. Postoperative CSF leak occurred in 10 cases (11.7%). Postoperative CSF infection happened in 4 cases (6%). Six patients (12%) presented new-onset diabetes insipidus after surgery. A total of 21 patients (31.3%) had at least 1 reoperation for recurrent or progressive disease, consisting of EETS in 17 cases (68%). Eighteen patients (26.9%) with residual and/or malignant tumors received adjuvant chemotherapy and/or radiotherapy.

EETS provides a safe and effective minimally invasive approach to treat a wide spectrum of skull base lesions in the pediatric age group.