Endoscopic transsphenoidal removal of neoplasms of the chiasmal-sellar region in children

The OBJECTIVE was to analyze the results of endoscopic transsphenoidal removal of neoplasms of the chiasmalsellar region in children.

MATERIALS AND METHODS. We studied 23 patients aged 3 to 17 years who underwent endoscopic transsphenoidal removal of neoplasms of the chiasmal-sellar region. Neurological, ophthalmological, endocrine disorders and otorhinolaryngological pathology were evaluated. Neuroimaging data (MRI and CT), results of laboratory tests were studied. In addition, the analysis of surgical treatment including intraoperative and early postoperative complications was performed.

RESULTS. In 39.1 % of cases, neoplasms of supraparainfracellar localization were diagnosed. In 34.8 % of patients, the size of the neoplasms did not exceed 2 cm. In 1 patient, the volume of neoplasm was 53.7 cm³. According to the type of pneumatization, the sellar type prevailed. Сonch type was observed in 1 child. Hemostatic material «Surgicel Fibrillar» was used more often (86.9 %). Plastic surgery of the skull defect was carried out on a floor-by-floor basis with «Tachocomb» plates (62.5 %). Total tumor removal was achieved in 75 % of children. The majority of neoplasms were represented by craniopharyngioma – 30.43 %. In the early postoperative period, there was a significant regression of neurological disorders – by 69.6 %, as well as ophthalmological – by 34.8 % and endocrine – by 37.8 %. There were no cases of nasal liquorrhea and epistaxis in children.

CONCLUSION. Our study demonstrated the success of removing neoplasms in children from 3 years old, regardless of the size of the nasal cavity and pneumatization of the sphenoid sinus. It is possible to use endoscopic transsphenoidal access in children to remove the neoplasms of the chiasmal-sellar region of more than 5 cm, since the risk of intra – and postoperative complications is minimized.

1. Aiyer R. G., Upreti Garima. Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study // Indian J Otolaryngol Head Neck Surg. 2020;72(1):36–43. Doi: 10.1007/s12070-019-01725-8. Epub 2019 Aug 19

2. Prieto R., Pascual J. M., & Barrios L. Harvey Cushing’s craniopharyngioma treatment: Part 2. Surgical strategies and results of his pioneering series // Journal of Neurosurgery. 2018;131(3):964–978. Doi: 10.3171/2018.5.jns18154.

3. Yadav Y. R., Nishtha Y., Vijay P., Shailendra R., Yatin K. Endoscopic endonasal trans-sphenoid management of craniopharyngiomas // Asian J Neurosurg Jan-Mar 2015;10(1):10–16. Doi: 10.4103/1793-5482.151502.

4. Fomichev D., Kalinin P., Kutin M., Sharipov O. Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas // World Neurosurgery. 2016;(94):181–187. Doi: 10.1016/j.wneu.2016.06.124.

5. Locatelli D., Veiceschi P., Castelnuovo P., Tanriover N., Evliyaoglu O., Canaz H., Gazioglu N. Transsphenoidal surgery for pituitary adenomas in pediatric patients: a multicentric retrospective study // Child’s Nervous System. 2019;35(11):2119–2126. Doi: 10.1007/s00381-019-04179-z.

6. Kobets A., Ammar A., Dowling K., Cohen A., & Goodrich J. The limits of endoscopic endonasal approaches in young children: a review // Child’s Nervous System. 2020;36(2):263–271. Doi: 10.1007/s00381-019-04455-y.

7. Ishikawa T., Takeuchi K., Nagatani T., Aimi Y., Tanemura E., Tambara M., Wakabayashi T. Quality of Life Changes Before and After Transsphenoidal Surgery for Sellar and Parasellar Lesions // World Neurosurgery. 2019;(122):E1202–E1210. Doi: 10.1016/j.wneu.2018.11.017.

8. Cherebillo V. Y., Kurnukhina M. Y. Quality of life in patients with pituitary adenomas in the pre- and postoperative period // Vopr. Neirokhir. Im. N. N. Burdenko. 2019;83(2):11–16. (In Russ.). Doi: 10.17116/neiro20198302111

9. Najera E., Snyderman C., & Fernandez-Miranda. J Endoscopic Endonasal Approach for Complex Macroadenoma with Suprasellar and Retrochiasmatic Extension // Journal of Neurological Surgery. Part B: Skull Base. 2018;79(03):284. Doi: 10.1055/s-0038-1625969.

10. Alalade A. F., Ogando-Rivas E., Boatey J., Souweidane M. M., Anand V. K., Greenfield J. P., Schwartz T. H. Suprasellar and recurrent pediatric craniopharyngiomas: expanding indications for the extended endoscopic transsphenoidal approach // J Neurosurg Pediatr. 2018; 21(1):72–80

11. Sankhla S. K., Jayashankar N., Khan G. M. Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results // J Pediatr Neurosci. 2015;10(4):308–316

12. Schelini J. C., Cavalheiro S., Dastoli P. A., Hirai É. R., Atallah C., Costa M., de Paula Santos R. Endoscopic endonasal transsphenoidal approach for pediatric craniopharyngiomas: a case series. International Journal of Pediatric Otorhinolaryngology. 2019. Doi: 10.1016/j.ijporl.2019.109786.

13. Patel V. S., Thamboo A., Quon J., Nayak J. V., Hwang P. H., Edwards M., Patel Z. M. Outcomes After Endoscopic Endonasal Resection of Craniopharyngiomas in the Pediatric Population // World Neurosurgery. 2017; (108):6–14. Doi: 10.1016/j.wneu.2017.08.058.

14. Levin O. S., Vasenina E. E., Gankina O. A., Chimagomedova A. S. Clinical scales in neurology. Moscow, Medpress-inform, 2019:192. (In Russ.).

15. Mazzatenta D., Zoli M., Guaraldi F., Ambrosi F., Fustini M. F., Pasquini E., Zucchelli M. Outcome of endoscopic endonasal surgery in pediatric craniopharyngiomas // World Neurosurgery. 2020;(134):E277–E288. Doi: 10.1016/j.wneu.2019.10.039.

16. Levy M., Nation J., Oviedo P. (2019). Approaching the Sella through the Nonpneumatized Sphenoid in Pediatric Patients // Journal of Neurological Surgery. Part B: Skull Base. 2020;81(1):56–61. Doi: 10.1055/s-0039-1679895.

17. Hamberger C. A., Hammer G., Norlen G., Sjogren B. Transantrosphenoidal hypophysectomy // Arch Otolaryngol 1961;(74):2–8.