Introduction: In selected cases, the transsphenoidal approach to pediatric craniopharyngiomas may be an acceptable and sometimes preferable surgical strategy. We report a consecutive series of 37 children from two pediatric neurosurgical centers treated with this approach. Advantages, disadvantages and outcomes are presented.
Methods: This series comprises 37 children ages 2.5 to 19 years operated upon for craniopharyngioma – 48% of whom had undergone prior surgical management. Follow-up averaged 42 months (range 1-147 months). All patients underwent sublabial or transnasal transsphenoidal approaches, with microscopic and/or endoscopic assistance.
Location and, routine transsphenoidal surgery or extended transsphenoidal endoscopic approaches (E) are as follows:
Intrasellar tumors- 7
Intrasellar and suprasellar- 18 (9E)
Suprasellar-Infundibular- 9 (6E)
Suprasellar-Retrosellar- 3 (3E)
Twenty-five patients presented with visual loss; only 2 (intrasellar lesions) had normal preoperative endocrine function.
Results: Gross total removal was accomplished in 66% of patients. Visual function improved in 60%, was unchanged in 32%, and worse in 8%. All but two of the patients required some form of pituitary hormone replacement therapy postoperatively, but the incidence of new postoperative hypothalamic obesity was remarkably low (8%). Major complications included one vascular injury –a pseudoaneurysm of the posterior cerebral artery which was adherent to the dome of a previously operated cystic recurrence. Initially there was a postoperative CSF leak rate of 15%, but with the adoption of the nasal septal flap repair technique this has not occurred in the most recent 12 cases.
Conclusions: This technique provides the advantages of direct visualization of sellar and suprasellar craniopharyngiomas. It is particularly helpful in lesions that arise and extend posterior to the optic chiasm. It is most suitable in children who have already lost pituitary function, as this is essentially always lost postoperatively. Technical obstacles such as CSF leaks can now be averted, and outcomes are highly satisfactory in most cases.
Patient Care: This work will describe the indications, utilization, outcome and potential complications of employing a surgical approach commonly used in adults to a novel population - children with craniopharyngioma - with the expectation of reducing surgical morbidity in a subgroup of tumors in specific locations
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of the transsphenoidal approach in the management of pediatric craniopharyngioma
2) Discuss, in small groups, the indications and limitations of the transsphenoidal approach in pediatric craniopharyngioma
3) Identify potential complications of the transsphenoidal approach in pediatric craniopharyngioma and methods to avoid these complications