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Updated: Sep 25, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Outcomes of endoscopic endonasal resection of pediatric craniopharyngiomas
Tapan D Patel1, Bianca Rullan-Oliver1, Heather Ungerer1
1Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Health System, Philadelphia, Pennsylvania, USA.
Insights
Endoscopic endonasal resection offers a viable treatment for pediatric craniopharyngioma, achieving high resection rates and low recurrence. However, pituitary dysfunction remains a significant concern.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Endocrinology
Background:
- Craniopharyngiomas traditionally treated with open transcranial surgery.
- Endoscopic endonasal approaches are emerging but lack long-term outcome data.
- Evaluating minimally invasive techniques for pediatric brain tumors is crucial.
Purpose of the Study:
- To evaluate the long-term outcomes of endoscopic endonasal resection for pediatric craniopharyngioma.
- To compare recurrence rates and complications with historical open transcranial approaches.
- To assess the efficacy and safety of minimally invasive surgery in pediatric patients.
Main Methods:
- Retrospective review of 42 pediatric craniopharyngioma patients treated from 2012-2020.
- Analysis of demographic, clinicopathologic, and outcome data, including follow-up and recurrence.
- Focus on presenting symptoms, symptom resolution, visual outcomes, and postoperative endocrine dysfunction.
Main Results:
- Mean patient age was 8.0 years with a median follow-up of 49 months.
- High resection rates achieved with a 9.5% recurrence rate.
- Significant postoperative morbidity including panhypopituitarism (89.7%) and diabetes insipidus (77.8%).
- Cerebrospinal fluid leak rate was 7.1%.
Conclusions:
- Endoscopic endonasal resection is effective for pediatric craniopharyngiomas, showing comparable or better outcomes than open surgery.
- Disease recurrence is low with the endoscopic approach.
- Hypothalamic-pituitary dysfunction is a significant complication, necessitating careful monitoring and management.
Background:
Craniopharyngiomas have traditionally been treated via open transcranial approaches. More recent, endoscopic endonasal approaches have been increasingly used; however, there has been limited evaluation of long-term outcomes for this approach.
Methods:
A retrospective review was performed to analyze patients with pediatric craniopharyngioma undergoing endonasal endoscopic resection from 2012 to 2020. Demographic information, clinicopathologic factors, and outcomes including follow-up and recurrences were analyzed.
Results:
All 42 patients, with a mean age of 8.0 years, were included. The median follow-up time was 49 months. Mean tumor diameter was 3.6 cm. All of the tumors had sellar and suprasellar components. The most common presenting symptoms were headaches (64.3%), visual changes (59.5%), and nausea/vomiting (38.1%). Most patients (73.3%) had resolution of their presenting symptoms by their first postoperative visit. Vision improved or remained normal in 69.0% of patients. Postoperatively, incidence of panhypopituitarism or diabetes insipidus developed in 89.7% and 77.8% of patients, respectively. The postoperative cerebrospinal fluid leak rate was 7.1%. The recurrence rate was 9.5%.
Conclusion:
Endoscopic endonasal resection for pediatric craniopharyngiomas can achieve high rates of resection with low rates of disease recurrence when compared with the outcomes of open transcranial resection reported in the literature. However, hypothalamic-pituitary dysfunction remains a significant postoperative morbidity in both approaches.
