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Transsphenoidal surgery for pituitary adenomas in pediatric patients: a multicentric retrospective study

  • Davide Locatelli
  • Pierlorenzo VeiceschiEmail author
  • Paolo Castelnuovo
  • Necmettin Tanriover
  • Olcay Evliyaoglu
  • Huseyin Canaz
  • Doga Ugurlar
  • Nurperi Gazioglu
Focus Session

Abstract

Introduction

Pediatric pituitary adenomas are rare lesions. Incidence is reported between 1 and 10% of all childhood brain tumors and between 3 and 6% of all surgically treated adenomas. Although pituitary adenomas present with symptoms of hormone hypersecretion or neurological disruptions secondary to mass effect, they are almost constantly benign. Characteristics of patients may vary in different studies according to age, gender, size of adenoma, hormonal activity, and recurrence rates.

Methods

Data on consecutive pediatric patients who were operated for pituitary adenoma with endoscopic endonasal transsphenoidal surgery (EETS) and transsphenoidal microsurgery (TMS) in the Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey, in the Neurosurgical Unit of the San Matteo Hospital, Pavia, Italy, and in the Division of Neurological Surgery Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy, between July 1997 and May 2018, were analyzed. Twenty-seven patients (11 males and 16 females), who were 18 years old or younger at the time of surgery, were included in the study. Medical records, images, and operative notes of patients were retrospectively reviewed.

Results

There were 16 females (59.3%) and 11 males (40.7%). Mean age was 15.3 ± 3.3 (4–18). Thirty-two surgical procedures were performed for 27 patients (6 children required second operation). Thirteen patients (48.14%) had Cushing’s disease (CD), 5 patients (18.5%) had growth hormone (GH)-secreting adenoma, 5 patients (18.5%) had prolactinoma, and 4 patients (14.8%) had non-functional adenoma. Twenty-two patients (81.4%) met remission criteria, and 5 patients (18.5%) did not meet remission criteria. Four patients met remission criteria after the second operation.

Conclusion

Transsphenoidal approach affords effective release of mass effect and not only restoration but also perpetuation of normal endocrine functions in the majority of pediatric pituitary adenoma patients. Satisfactory results are reported with both EETS and TMS in the literature. Despite the technical difficulties in pediatric age, transsphenoidal resection of adenoma is still the mainstay treatment that provides cure in pediatric patients.

Keywords

Pediatric pituitary adenomas Endoscopic endonasal transsphenoidal surgery Transsphenoidal microsurgery Remission Outcome Skull base 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Davide Locatelli
    • 1
  • Pierlorenzo Veiceschi
    • 1
    Email author
  • Paolo Castelnuovo
    • 2
  • Necmettin Tanriover
    • 3
  • Olcay Evliyaoglu
    • 4
  • Huseyin Canaz
    • 5
  • Doga Ugurlar
    • 5
  • Nurperi Gazioglu
    • 5
  1. 1.Division of Neurosurgery, Department of Biotechnology and Life SciencesUniversity of InsubriaVareseItaly
  2. 2.Division of Otorhinolaryngology, Department of Biotechnology and Life SciencesUniversity of InsubriaVareseItaly
  3. 3.Department of NeurosurgeryIstanbul University CerrahpasaIstanbulTurkey
  4. 4.Department of Pediatric EndocrinologyIstanbul University CerrahpasaIstanbulTurkey
  5. 5.Department of NeurosurgeryDemiroğlu Bilim UniversityIstanbulTurkey

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