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Child's Nervous System

, Volume 29, Issue 11, pp 2065–2070 | Cite as

Suprasellar pediatric craniopharyngioma resection via endonasal endoscopic approach

  • Zarina S. AliEmail author
  • Shih-Shan Lang
  • Ameet R. Kamat
  • Nithin D. Adappa
  • James N. Palmer
  • Phillip B. Storm
  • John Y. K. Lee
Original Paper

Abstract

Purpose

Purely endoscopic endonasal approaches to surgical resection of pediatric suprasellar craniopharyngiomas are uncommonly performed. The aim of the study is to assess the feasibility and to describe the short-term outcomes of endonasal endoscopic approaches for the gross total resection of suprasellar craniopharyngiomas in the pediatric population.

Methods

A combined neurosurgical–otolaryngologic team performed gross total resection of craniopharyngiomas in seven pediatric patients (mean age 9.6 years) at The Children’s Hospital of Philadelphia over 2011–2012. Short-term outcomes were analyzed over a mean follow-up period of 6.3 months.

Results

All tumors involved the sellar and/or suprasellar space and contained some cystic component. The mean maximal tumor diameter was 31.5 mm (range 18.5–62.0 mm). Using a binostril approach, gross total tumor resection was obtained in all patients (100 %). All patients with preoperative visual dysfunction demonstrated improvement in visual acuity. New or stable panhypopituitarism was observed in all cases. All patients developed postoperative diabetes insipidus, and cerebrospinal fluid leak occurred in one patient (15 %).

Conclusions

Complete radiographic resection of pediatric craniopharyngioma can be achieved via a purely endoscopic endonasal approach. In particular, this approach can be performed safely using the “two-nostrils-four-hands” technique with intraoperative neuronavigation. This approach should be highly considered in patients with progressive visual dysfunction. Further studies are needed to characterize the long-term surgical and clinical outcome of pediatric patients treated with this surgical approach.

Keywords

Craniopharyngioma Pediatric Endoscopic approaches Endoscopic transsphenoidal 

Notes

Conflict of interest

The authors have no conflicts of interest to disclose.

Supplementary material

ESM 1

(MOV 24754 kb)

References

  1. 1.
    Abe T, Ludecke DK (1999) Transnasal surgery for infradiaphragmatic craniopharyngiomas in pediatric patients. Neurosurgery 44:957–964, discussion 964–956PubMedCrossRefGoogle Scholar
  2. 2.
    Adappa ND, Learned KO, Palmer JN, Newman JG, Lee JY (2012) Radiographic enhancement of the nasoseptal flap does not predict postoperative cerebrospinal fluid leaks in endoscopic skull base reconstruction. Laryngoscope 122:1226–1234PubMedCrossRefGoogle Scholar
  3. 3.
    Briner HR, Simmen D, Jones N (2005) Endoscopic sinus surgery: advantages of the bimanual technique. Am J Rhinol 19:269–273PubMedGoogle Scholar
  4. 4.
    Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM (1998) The descriptive epidemiology of craniopharyngioma. J Neurosurg 89:547–551PubMedCrossRefGoogle Scholar
  5. 5.
    Cappabianca P, Cavallo LM (2012) The evolving role of the transsphenoidal route in the management of craniopharyngiomas. World neurosurg 77:273–274PubMedCrossRefGoogle Scholar
  6. 6.
    Carmel PW, Antunes JL, Chang CH (1982) Craniopharyngiomas in children. Neurosurgery 11:382–389PubMedCrossRefGoogle Scholar
  7. 7.
    Castelnuovo P, Pistochini A, Locatelli D (2006) Different surgical approaches to the sellar region: focusing on the "two nostrils four hands technique". Rhinology 44:2–7PubMedGoogle Scholar
  8. 8.
    Cavallo LM, de Divitiis O, Aydin S, Messina A, Esposito F, Iaconetta G, Talat K, Cappabianca P, Tschabitscher M (2007) Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations–part 1. Neurosurgery 61:24–33, discussion 33–24PubMedCrossRefGoogle Scholar
  9. 9.
    Chakrabarti I, Amar AP, Couldwell W, Weiss MH (2005) Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg 102:650–657PubMedCrossRefGoogle Scholar
  10. 10.
    Chan DG, Francis IC (2004) Transsphenoidal diplopia. Surv Ophthalmol 49:618–619, author reply 619PubMedGoogle Scholar
  11. 11.
    de Divitiis E, Cappabianca P, Gangemi M, Cavallo LM (2000) The role of the endoscopic transsphenoidal approach in pediatric neurosurgery. Child's Nerv Syst 16:692–696CrossRefGoogle Scholar
  12. 12.
    Di Rocco C, Caldarelli M, Tamburrini G, Massimi L (2006) Surgical management of craniopharyngiomas—experience with a pediatric series. J Pediatr Endocrinol Metab 19(Suppl 1):355–366PubMedGoogle Scholar
  13. 13.
    Duff J, Meyer FB, Ilstrup DM, Laws ER Jr, Schleck CD, Scheithauer BW (2000) Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46:291–302, discussion 302–295PubMedCrossRefGoogle Scholar
  14. 14.
    Elliott RE, Hsieh K, Hochm T, Belitskaya-Levy I, Wisoff J, Wisoff JH (2010) Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children. J Neurosurg Pediatr 5:30–48PubMedCrossRefGoogle Scholar
  15. 15.
    Elliott RE, Sands SA, Strom RG, Wisoff JH (2010) Craniopharyngioma clinical status scale: a standardized metric of preoperative function and posttreatment outcome. Neurosurg Focus 28:E2PubMedCrossRefGoogle Scholar
  16. 16.
    Esposito F, Dusick JR, Fatemi N, Kelly DF (2007) Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 60:295–303, discussion 303–294PubMedCrossRefGoogle Scholar
  17. 17.
    Frazier JL, Chaichana K, Jallo GI, Quinones-Hinojosa A (2008) Combined endoscopic and microscopic management of pediatric pituitary region tumors through one nostril: technical note with case illustrations. Child's Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 24:1469–1478CrossRefGoogle Scholar
  18. 18.
    Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882–1886PubMedCrossRefGoogle Scholar
  19. 19.
    Im SH, Wang KC, Kim SK, Chung YN, Kim HS, Lee CH, Cho BK (2003) Transsphenoidal microsurgery for pediatric craniopharyngioma: special considerations regarding indications and method. Pediatr Neurosurg 39:97–103PubMedCrossRefGoogle Scholar
  20. 20.
    Jane JA Jr, Prevedello DM, Alden TD, Laws ER Jr (2010) The transsphenoidal resection of pediatric craniopharyngiomas: a case series. J Neurosurg Pediatr 5:49–60PubMedCrossRefGoogle Scholar
  21. 21.
    Jang YJ, Kim SC (2000) Pneumatization of the sphenoid sinus in children evaluated by magnetic resonance imaging. Am J Rhinol 14:181–185PubMedCrossRefGoogle Scholar
  22. 22.
    Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108:715–728PubMedCrossRefGoogle Scholar
  23. 23.
    Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63: ONS44-52; discussion ONS52-43Google Scholar
  24. 24.
    Laws ER Jr (1994) Transsphenoidal removal of craniopharyngioma. Pediatr Neurosurg 21(Suppl 1):57–63PubMedCrossRefGoogle Scholar
  25. 25.
    Laws ER Jr, Trautmann JC, Hollenhorst RW Jr (1977) Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients. J Neurosurg 46:717–722PubMedCrossRefGoogle Scholar
  26. 26.
    Learned KO, Adappa ND, Loevner LA, Palmer JN, Newman JG, Lee JY (2012) MR imaging evaluation of endoscopic cranial base reconstruction with pedicled nasoseptal flap following endoscopic endonasal skull base surgery. Eur J RadiolGoogle Scholar
  27. 27.
    Lee JM, Palmer JN (2011) Indications for the osteoplastic flap in the endoscopic era. Curr Opin Otolaryngol Head Neck Surg 19:11–15PubMedCrossRefGoogle Scholar
  28. 28.
    Locatelli D, Castelnuovo P, Santi L, Cerniglia M, Maghnie M, Infuso L (2000) Endoscopic approaches to the cranial base: perspectives and realities. Child's Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 16:686–691CrossRefGoogle Scholar
  29. 29.
    Locatelli D, Massimi L, Rigante M, Custodi V, Paludetti G, Castelnuovo P, Di Rocco C (2010) Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 74:1298–1302PubMedCrossRefGoogle Scholar
  30. 30.
    Maira G, Anile C, Rossi GF, Colosimo C (1995) Surgical treatment of craniopharyngiomas: an evaluation of the transsphenoidal and pterional approaches. Neurosurgery 36:715–724PubMedCrossRefGoogle Scholar
  31. 31.
    Rigante M, Massimi L, Parrilla C, Galli J, Caldarelli M, Di Rocco C, Paludetti G (2011) Endoscopic transsphenoidal approach versus microscopic approach in children. Int J Pediatr Otorhinolaryngol 75:1132–1136PubMedCrossRefGoogle Scholar
  32. 32.
    Tan HK, Ong YK, Teo MS, Fook-Chong SM (2003) The development of sphenoid sinus in Asian children. Int J Pediatr Otorhinolaryngol 67:1295–1302PubMedCrossRefGoogle Scholar
  33. 33.
    Teo C (2005) Application of endoscopy to the surgical management of craniopharyngiomas. Childs Nerv Syst 21:696–700PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Zarina S. Ali
    • 1
    Email author
  • Shih-Shan Lang
    • 1
  • Ameet R. Kamat
    • 2
  • Nithin D. Adappa
    • 2
  • James N. Palmer
    • 2
  • Phillip B. Storm
    • 1
    • 3
  • John Y. K. Lee
    • 1
  1. 1.Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Otorhinolaryngology–Head and Neck SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Division of NeurosurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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