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Combined endoscopic and microscopic management of pediatric pituitary region tumors through one nostril: technical note with case illustrations

  • Technical Note
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Abstract

Objective

Sellar and parasellar lesions in the pediatric population have traditionally been approached through either a transsphenoidal hypophysectomy or craniotomy or a combination of the two, with the surgical approach being dictated by the anatomical location and extent of the pathology. The introduction and evolution of the endonasal endoscopic technique has provided a minimally invasive method alone or in combination with the operative microscope for removal of these lesions in the pediatric population. The authors have implemented in their practice the use of endonasal endoscopic-assisted microsurgery in the pediatric population harboring sellar and/or lesions extending to the suprasellar space and report our experience in nine patients.

Materials and methods

Five craniopharyngiomas, one Rathke’s cleft cyst, and two pituitary tumors were treated via endonasal endoscopic-assisted microsurgery. Histopathologic examination revealed lymphocytic hypophysitis in one patient with an enhancing lesion in the pituitary stalk. The approach utilized by the authors is performed through one nostril without any resection of the nasal turbinates or nasal septum. The middle turbinate is displaced laterally, while the nasal septum is moved medially.

Conclusion

Gross total, near-total, and subtotal resections and a diagnostic biopsy were obtained in six, one, one, and one patients, respectively. The authors were able to safely perform this procedure in nine pediatric patients, and the lack of turbinate or septum resection minimized postoperative discomfort.

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    James L. Frazier, Kaisorn Chaichana, George I. Jallo & Alfredo Quiñones-Hinojosa

  2. Brain Tumor Stem Cell Laboratory, Department of Neurosurgery and Oncology, The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, 1550 Orleans Street, Cancer Research Building II Room 247, Baltimore, MD, 21231, USA

    Alfredo Quiñones-Hinojosa

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  1. James L. Frazier
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Frazier, J.L., Chaichana, K., Jallo, G.I. et al. Combined endoscopic and microscopic management of pediatric pituitary region tumors through one nostril: technical note with case illustrations. Childs Nerv Syst 24, 1469–1478 (2008). https://doi.org/10.1007/s00381-008-0710-9

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