Locatelli Davide, Massimi Luca, Rigante Mario, Custodi Viola, Paludetti Gaetano, Castelnuovo Paolo, Di Rocco Concezio
Department of Neurosurgery, San Matteo Hospital, Pavia, Italy.
Int J Pediatr Otorhinolaryngol. 2010 Nov;74(11):1298-302. doi: 10.1016/j.ijporl.2010.08.009. Epub 2010 Sep 9.
Endoscopic endonasal transsphenoidal surgery (EETS) is still rarely used in pediatric subjects compared with adults. Reports on EETS in children appeared only recently in the literature, usually regarding small series. The aim of the study is to assess the actual role and the limits of EETS in children with sellar tumors by reporting a two-centers experience.
Twenty-seven children (mean age: 12.2 years) were operated on during the last decade. Seventeen patients harbored a sellar mass, 7 a suprasellar tumor, and 3 a clival mass. Laboratory investigations revealed hypopituitarism in 6 children and hormone hypersecretion in 9. All the operations were carried out by a team including both ENT surgeon and neurosurgeon using a dedicated 18-cm long rigid endoscope (2.7 mm and 4 mm diameter) through the direct paraseptal or the transethmoidal or the transpterygoid route.
Overall, 29 operations were performed. Gross total tumor resection was obtained in 22 children (81.5%) while a subtotal and a partial removal in 2 (7.5%) and 3 cases (11%), respectively. Pituitary adenoma was the most common histotype (12 cases), followed by craniopharyngioma (5) and Rathke's cleft cyst (4). No surgical mortality or neurological morbidity or late nasal complications were observed. Postoperative CSF fistula occurred in 3 patients. All children are alive at current follow-up (average: 8.6 years). Preoperative hypopituitarism disappeared or improved in 4 cases and was stable in the remaining 2 (no new hormone deficits appeared).
EETS is a safe and effective surgical option also in children. As for adults, it allows to manage most of the tumor lesions of the sellar region with stable long-term results.
与成人相比，鼻内镜下经蝶窦手术（EETS）在儿科患者中的应用仍然很少。关于儿童EETS的报道最近才出现在文献中，通常是关于小样本系列研究。本研究的目的是通过报告两个中心的经验，评估EETS在患有鞍区肿瘤儿童中的实际作用和局限性。
在过去十年中，对27名儿童（平均年龄：12.2岁）进行了手术。17例患者患有鞍区肿块，7例患有鞍上肿瘤，3例患有斜坡肿块。实验室检查显示6例儿童存在垂体功能减退，9例存在激素分泌过多。所有手术均由包括耳鼻喉科医生和神经外科医生在内的团队进行，使用专用的18厘米长硬性内镜（直径2.7毫米和4毫米），通过直接鼻中隔旁、经筛窦或经翼突途径进行。
总体而言，共进行了29次手术。22例儿童（81.5%）实现了肿瘤全切，2例（7.5%）为次全切，3例（11%）为部分切除。垂体腺瘤是最常见的组织学类型（12例），其次是颅咽管瘤（5例）和拉克氏囊肿（4例）。未观察到手术死亡、神经并发症或晚期鼻部并发症。3例患者发生术后脑脊液漏。在目前的随访中（平均：8.6年），所有儿童均存活。术前垂体功能减退在4例中消失或改善，其余2例稳定（未出现新的激素缺乏）。
EETS在儿童中也是一种安全有效的手术选择。与成人一样，它能够处理大多数鞍区肿瘤病变，并取得稳定的长期效果。
