Related Experiment Video
Updated: Jun 17, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The transsphenoidal resection of pediatric craniopharyngiomas: a case series
John A Jane1, Daniel M Prevedello, Tord D Alden
1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. johnjanejr@virginia.edu
Insights
Transsphenoidal resection is effective for pediatric craniopharyngiomas, achieving high rates of gross-total resection (GTR) and visual improvement with low recurrence risk. This approach is a viable option for selected young patients.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Endocrinology
Background:
- Craniopharyngiomas are common pediatric brain tumors, often treated with transcranial surgery.
- Transsphenoidal resection is increasingly used in adults but less reported in pediatric cases.
- The study focuses on outcomes of transsphenoidal surgery for pediatric craniopharyngiomas with the aim of gross-total resection (GTR).
Purpose of the Study:
- To evaluate the outcomes of transsphenoidal resection in pediatric craniopharyngioma patients.
- To assess the feasibility and efficacy of the transsphenoidal approach for achieving GTR in this population.
- To report on recurrence rates, functional outcomes, and complications associated with the procedure.
Main Methods:
- Retrospective review of 22 pediatric patients (≤18 years) with craniopharyngiomas treated at a single institution.
- Inclusion of patients who underwent transsphenoidal surgery, either primarily or secondarily.
- Analysis of surgical outcomes, including degree of resection, recurrence, pituitary function, visual recovery, and complications.
Main Results:
- Gross-total resection (GTR) was achieved in 68% of patients.
- Recurrence occurred in 18% of patients, with lower rates after GTR and primary transsphenoidal surgery.
- Significant rates of new panhypopituitarism (67%) and diabetes insipidus (56%) were observed, while 64% of patients with visual loss experienced improvement.
- Complications included one death, two CSF leaks, and new-onset obesity in 37%.
Conclusions:
- Transsphenoidal resection offers a high rate of GTR and visual improvement for pediatric craniopharyngiomas.
- The approach is associated with a low risk of recurrence, particularly when performed as a primary procedure.
- Transsphenoidal surgery is a valuable option for selected pediatric craniopharyngioma cases, especially those with infradiaphragmatic tumors.
Object:
The majority of pediatric craniopharyngiomas are treated using a transcranial approach. Although there is an increasing acceptance of transsphenoidal resection in adults, there are few reports describing this approach in the pediatric population. The purpose of this study is to report the outcomes after transsphenoidal surgery in a consecutive series of pediatric patients with craniopharyngiomas treated at a single institution with the goal of gross-total resection (GTR).
Methods:
Twenty-three patients with pathologically proven craniopharyngiomas were identified who were 18 years of age or less at the time of surgery. The medical records and imaging studies of the patients were retrospectively reviewed. One patient who was lost to follow-up after surgery was excluded.
Results:
Among the 22 patients included in the study, 11 underwent transsphenoidal surgery as the primary procedure and 11 underwent transsphenoidal surgery as a secondary procedure after a previous procedure. All patients had at least some sellar component to their tumor and all had either anterior or posterior pituitary dysfunction at presentation. In the entire cohort, a GTR was achieved in 15 (68%) of 22 patients, a radical subtotal resection in 4 (18%) of 22 patients, a subtotal resection in 1 patient, and a partial resection in 2 patients. The degree of resection was higher in the primary transsphenoidal group. After a mean follow-up of 82 months, 4 patients (18%) experienced recurrence. Recurrence occurred in 13% after GTR compared with 28.5% after all other degrees of resection. Tumor recurred in 9% of the primary transsphenoidal group and in 30% of patients who had undergone other therapies prior to the transsphenoidal operation. No patient who had panhypopituitarism experienced a gain of function postoperatively, 67% developed new panhypopituitarism, and 56% experienced new diabetes insipidus. Vision improved or normalized in 9 (64%) of 14 patients presenting with visual loss. Complications included 1 death 3 weeks postoperatively, 2 CSF leaks, and new obesity in 37%.
Conclusions:
Transsphenoidal resection of pediatric craniopharyngiomas results in a high rate of both visual improvement and GTR with a low associated risk of recurrence. The transsphenoidal approach should be considered in selected pediatric patients with craniopharyngioma, especially those with infradiaphragmatic origin.
