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Endoscopic endonasal transsphenoidal surgery in children: Necker - Enfants Malades Hospital experience
Léa Fath1, François Simon2, Hakim Benkhatar3
1Hôpitaux Universitaires de Strasbourg - Service d'Oto-rhino-laryngologie et de Chirurgie Cervico-Faciale, Strasbourg, France.
Insights
Endoscopic endonasal transsphenoidal surgery is a safe and effective minimally invasive approach for treating sellar and parasellar lesions in children. This pediatric surgery technique avoids open surgery complications and yields good outcomes.
Area of Science:
- Pediatric Neurosurgery
- Endoscopic Skull Base Surgery
- Pediatric Otolaryngology
Background:
- Sellar and parasellar lesions in children require specialized surgical approaches.
- Minimally invasive techniques are increasingly preferred to avoid the morbidity of open surgery.
Purpose of the Study:
- To analyze outcomes of pediatric patients undergoing transsphenoidal surgery for sellar/parasellar lesions.
- To evaluate the feasibility and safety of a dual-team (neurosurgery and ENT) approach.
Main Methods:
- Observational study of 75 children (<18 years) undergoing endoscopic endonasal transsphenoidal surgery.
- Procedures performed by neurosurgical and ENT teams, alternating as first operator.
- Data collected retrospectively from 2005-2018.
Main Results:
- 123 procedures included 75 primary tumor resections, 5 biopsies, and 53 revision procedures.
- Post-operative cerebrospinal fluid (CSF) leaks occurred in 13.3% of patients, and meningitis in 6.7%, with no sequelae.
- No deaths were reported during the study period.
Conclusions:
- Minimally invasive transsphenoidal endonasal surgery is feasible in pediatric patients.
- This approach allows safe excision of sellar/parasellar lesions in children.
- It effectively avoids the comorbidities associated with open surgical techniques.
Objective:
This study aimed to analyze a large series of children treated transsphenoidally by both neurosurgical and Ear Nose Throat (ENT) surgical teams for sellar or parasellar lesions.
Study Design:
It was an observational study in a French pediatric tertiary referral center.
Setting:
The patients included were under 18 years of age at time of surgery, had no open neurosurgical history, and required endoscopic endonasal transsphenoidal surgery.
Methods:
All endoscopic endonasal procedures were conducted by both neurosurgeon and ENT surgeon alternating as first operator according to the different phases of the operation. Data collection was carried out using the Dr Warehouse data platform.
Results:
From 2005 to 2018, 75 children (41 boys and 34 girls) were included retrospectively. The average age at the time of surgery was 10 years [range: 3-17]. One hundred twenty-three procedures were performed: 75 primary tumour resections (17 partial (22.7 %), 35 (46.7 %) near total and 18 (24 %) total resections), 5 biopsies, 45 revision procedures for tumour recurrences or residuals and 3 revision procedures for post-operative cerebrospinal fluid (CSF) leaks. 10 patients (13.3 %) had post-operative CSF leaks and 5 patients (6.7 %) developed meningitis without any sequelae. No death occurred.
Conclusion:
The minimally invasive transsphenoidal endonasal surgery is feasible in the pediatric population, allows excision of sellar and parasellar lesions in children without major complications, and avoids open technique comorbidities.
