Transpalatal transsphenoidal approach to the sella in children

The sublabial transseptal transsphenoidal approach provides excellent exposure for pituitary surgery in adults. However, sellar lesions in children are more difficult to approach because of the smaller size of the pyramidal aperture and because of the limited pneumatization of the sella. We resurrected the transpalatal transsphenoidal approach for the treatment of sellar lesions in three children (one adenoma and two cystic craniopharyngiomas). The advantages of this approach were a short working distance and a wide exposure that permitted extensive drilling of the poorly pneumatized sphenoid bone under direct vision. The technique successfully provided exposure for management of the sellar pathology in all three cases and resulted in no nasal or palatal defects.