Transnasal Transsphenoidal Surgical Method in Pediatric Pituitary Adenomas

Taşkapılıoğlu, Mevlüt Özgür; Yılmazlar, Selçuk; Eren, Erdal; Tarım, Ömer; Guler, Tugba Morali

doi:10.1159/000381862

Cited by 13 publications

(6 citation statements)

References 27 publications

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“…Literature reports on children treated by means of an endoscopic skull base approach are sparse, with the largest study consisting of 133 patients [5], followed by a 28-patient retrospective study [8], both of which describing a relatively homogeneous spectrum of pathologies. As already discussed in relation to complications, in fact, the most common endoscopically treated conditions that are described are encephalocele, meningoencephalocele [4,8,10,22,24], and pituitary adenomas [5,16,21,25]. It is, however, described that a broader range of pathological entities results in a higher rate of complications [5,18].…”

Section: Discussionmentioning

confidence: 96%

“…Nowadays these extracranial approaches are preferred in the adult population mainly due to its minimal invasive character, with a few exceptions and contraindications such as anatomical anomalies, for example, "kissing carotids", or particular configuration of the lesions. The same cannot always be applied to children, although in recent years, the technique has been used increasingly in some pediatric cohorts [22,24,25]. Specifically, the incomplete pneumatization of the sphenoid sinus, the thickness of the bone and the intercarotid distance in pediatric skull base anatomy influence the surgical planning to calculate the distance to the structures such as planum sphenoidale, tuberculum sellae, dorsum sellae, or clivus [26].…”

Section: Introductionmentioning

confidence: 99%

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First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

et al. 2021

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Introduction Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series. Patients and methods A retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed. Results The mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery. Conclusion The implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

et al. 2021

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“…In this group of 38 cases, ve were children and 33 were adolescents, suggesting that PA incidence may be related to changes in adolescent hormone levels. Biological characteristics of PAs in children and adolescents include: high rates of functional PAs [25], high rates of invasive PAs [33], and high rates of apoplexy [10]. In adults, temozolomide may be used for aggressive PA, PCs, and APAs [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…This study was a single-center study of 38 patients with surgically-treated PA, admitted to the Sanbo Brain Hospital, Capital Medical University, from June 2012 to September 2017. The age range of reported PA in adolescents is 18-21 years [2,9,[25][26][27]. Patients 20 years or younger with PA were included in this study.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of 06-methylguanine-DNA methyltransferase expression in children and adolescent pituitary adenoma

Shen¹,

Yang²,

Yang³

et al. 2020

Preprint

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BackgroundTemozolomide can be used in the treatment of pituitary adenoma. Its efficacy can be evaluated by the expression of 06-methylguanine-DNA methyltransferase (MGMT). However, the previous study population was mainly adult. This study was the first to evaluate the expression of MGMT in children and adolescents with pituitary adenomas.MethodsThe clinical features and biological characteristics of 38 cases of pituitary adenoma in children and adolescents were analyzed retrospectively. The expression of MGMT, Ki-67, p53 was marked by immunohistochemical staining.ResultsIn this cohort, the expression of MGMT protein is 16/38 (42.11%). The low expression rate of MGMT in children and adolescent somatotroph adenomas was only 11.11%, which was much lower than that of adults. Ki-67 expression range of 1% -10%（mean 4.24 ± 2.71%）. The positive rate of p53 was 22/38 (57.89%). The statistical analysis showed that the expression of MGMT was related to the diameter of the tumor (P=0.01), the diameter of the tumor was large, and the expression of MGMT was high. The expression of MGMT was not associated with age, sex, tumor type, invasiveness, texture, apoplexy, recurrence, and expression of p53 and Ki-67.ConclusionSomatotroph adenomas, large-diameter children and adolescent pituitary adenomas may be not suitable for temozolomide treatment. To determine whether temozolomide responds to salvage therapy in children and adolescents with pituitary adenomas, MGMT expression should be assessed in all pituitary adenomas, the time span between specimen collection and temozolomide treatment needs to be considered because of the instability of MGMT protein expression.

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“…4 As such, most research studies to date have focused on safety outcomes related to this surgical approach as well as the impact on craniofacial development. 1,[4][5][6][7][8][9][10][11] Now that this technique has been found to be safe in this cohort of patients, we sought to explore the symptomatic impact of endoscopic ACB surgery on sinonasal quality-of-life outcomes. Most studies addressing outcomes for pediatric ACB patients compare complications and long-term adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Sinonasal Symptom Outcomes following Endoscopic Anterior Cranial Base Surgery in the Pediatric Population

Carle

Wung

Heaney

et al. 2021

J Neurol Surg B Skull Base

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Objective This study aimed to evaluate the impact of endoscopic anterior cranial base (ACB) surgery on sinonasal symptoms in the pediatric population utilizing the Sino-Nasal Outcome Test (SNOT)-22 questionnaire. Design This is a retrospective review. Setting The study was conducted at a tertiary academic medical center. Participants Thirty-four consecutive patients, age 6 to 17 years, M:F 14:20, who underwent endoscopic ACB surgery from July 2008 to August 2019. Ten patients had baseline and a minimum of two subsequent postoperative SNOT-22 questionnaires available for analysis. Main Outcome Measures Baseline and postoperative SNOT-22 scores were compared. The mean change from baseline sinonasal symptom scores in the pediatric and historical adult cohorts was compared. Results The mean baseline SNOT-22 score for our 10 patient cohort was 0.46 out of 5 for each of the first 10 sinonasal-specific questions. This worsened to 1.69 at 1 month and returned to near baseline, 0.7, at 3 months postoperatively. The mean quality-of-life score improved to 0.91 at 1 month and 0.6 at 3 months postoperatively. The mean change from baseline for the following items: need to blow nose, runny nose, postnasal discharge, thick nasal discharge, wake up at night, reduced concentration, and frustrated/restless/irritable were similar to those in our historical adult cohort at 3 months postoperatively. Conclusion Endoscopic ACB surgery in the pediatric population results in increased sinonasal symptom morbidity in the early postoperative period; however, symptoms return to near baseline by ∼3 months, and quality-of-life scores progressively improve in the postoperative period. These trends were similar to those seen in our historic adult cohort.

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Transnasal Transsphenoidal Surgical Method in Pediatric Pituitary Adenomas

Cited by 13 publications

References 27 publications

First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

Evaluation of 06-methylguanine-DNA methyltransferase expression in children and adolescent pituitary adenoma

Sinonasal Symptom Outcomes following Endoscopic Anterior Cranial Base Surgery in the Pediatric Population

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