Contemporary series of transsphenoidal microsurgery in pediatric patients

Pituitary tumors are rare in the pediatric population, accounting for less than 10% of childhood tumors. Craniopharyngiomas are the most common pediatric sellar lesions, but pituitary adenomas/PitNETs also occur, representing 2-8% of all sellar lesions. This study explores a decade of transsphenoidal microsurgery on pediatric patients, examining perioperative features including complications, clinical outcomes and anatomical peculiarities. This retrospective study included a total of 147 transsphenoidal surgeries performed by a single surgeon on 122 pediatric patients under the age of 18 between 2013 and 2023. Parameters assessed included age, gender, clinical hormone production, histopathological and radiographic parameters, surgical features, postoperative complications and recurrences rate. Among 122 pediatric patients with pituitary lesions, we found that craniopharyngiomas were the most common entity (34.4%), especially in children under 10 years old (58.6%). Pituitary adenomas/PitNETs accounted for 31.1% and were more prevalent in older children, with corticotrophic and lactotrophic adenomas being the most common subtypes. Younger patients needed significantly more time for surgery, with the longest durations observed in the 3-9 years age group and the shortest in the 16-17 years age group. Additionally, sphenoid sinus pneumatization increased with age and was inversely correlated with the duration of surgery. The current study is one of the largest to date on pediatric pituitary region lesions shedding light on demographic, clinical and histopathological features. The age-dependent distribution pattern highlights the prominence of craniopharyngiomas in younger patients, while PPAs became increasingly prevalent in those older than 10 years.