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Pediatric transseptal transsphenoidal pituitary surgery
L J Orvidas1, J L Kasperbauer, F B Meyer
1Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Transseptal transsphenoidal surgery for pituitary tumors is effective in pediatric patients. While generally safe, potential long-term complications include nasal obstruction and deformity.
Area of Science:
- Neurosurgery
- Pediatric Endocrinology
Background:
- Transseptal transsphenoidal surgery is a common approach for pituitary tumor removal in adults.
- Outcomes in pediatric patients, particularly those with developing nasal structures, are less understood.
Purpose of the Study:
- To evaluate the safety and efficacy of transseptal transsphenoidal pituitary surgery in pediatric patients.
- To identify early and long-term complications associated with this surgical approach in a young population.
Main Methods:
- Retrospective review of 41 pediatric patients (<18 years) who underwent transseptal transsphenoidal pituitary surgery between 1986 and 1997.
- Analysis of diagnoses, presenting symptoms, surgical outcomes, complications, and long-term follow-up data.
Main Results:
- Prolactin-secreting adenoma and craniopharyngioma were the most common diagnoses.
- Transient diabetes insipidus was the most frequent early complication (20 patients).
- Long-term complications included nasal obstruction (5 patients), recurrent sinus infections (4 patients), and nasal deformity (4 patients).
Conclusions:
- Transseptal transsphenoidal surgery is a viable option for pediatric pituitary tumors, with successful outcomes.
- Careful monitoring for potential long-term nasal complications is recommended in pediatric patients.
Abstract:
The use of the transseptal transsphenoidal approach to the pituitary gland has gained acceptance as a safe, relatively atraumatic means of removing pituitary tumors. The outcome in adult patients has been successful; however, the outcome in pediatric patients whose noses may still be developing is not well described. We reviewed the outcomes in 41 patients younger than age 18 years who underwent transseptal transsphenoidal pituitary surgery at our institution between 1986 and 1997 (20 boys and 21 girls; age, 3 to 17 years; mean age, 13.4 years). The most common diagnosis was prolactin-secreting adenoma (14 patients), followed by craniopharyngioma (7 patients). Presenting symptoms included headache (20 patients), galactorrhea (13 patients), and menstrual irregularities (11 patients). The most common early complication was transient diabetes insipidus (20 patients). No patient experienced serious bleeding at pack removal and no patient developed a cerebrospinal fluid leak postoperatively. Follow-up ranged from 3 months to 12.7 years, with 7 patients experiencing recurrent or residual disease between 6 days and 2 years after their original transseptal procedure. The most common long-term surgical complication was nasal obstruction in 5 patients, 3 of whom also complained of seasonal allergies. Four patients complained of recurrent sinus infections, and 4 patients noted an external nasal deformity as a result of the surgery.