Feasibility of Endoscopic Endonasal Transsphenoidal Approach for Craniopharyngioma Removal in Very Young Children: A Case Series of 5 Patients

Introduction: The endoscopic endonasal transsphenoidal approach (EETS) has become increasingly used for craniopharyngioma surgery in the pediatric population, but questions still arise regarding its utility in younger children. The narrow surgical corridor, the incomplete pneumatization of the cranium in little children, and the fear of hypothalamic injury have traditionally relegated this approach to older children. The authors present a series of 5 consecutive pediatric patients, with age under 6 years old, that underwent surgery for craniopharyngioma removal with an endoscopic endonasal transsphenoidal approach.

Material and Methods: The databank of “Anna Meyer” Children’s Hospital in Florence was used to collect the data. In a period included between January 2011 and January 2022, a total of 123 consecutive pediatric patients (age ≤ 18 years), with skull base lesions, underwent surgery via an EETS. In 29 patients, the lesion resulted being a craniopharyngioma, among these, 5 patients presented an age less than 6 years old, at the moment of surgery. Our study focuses on the latter group of patients. The clinical, radiological and intraoperatory data of all patients were available. Patients were then evaluated through regular follow-up appointments in a dedicated outpatient clinic, and checking with the fibroscope was performed in all cases.

Results: The mean age of the patients was 3.9 years old. The mean follow-up is 6 years. In all 5 patients, the craniopharyngioma presented both a solid and a cystic component and had conchalsphenoid aeration. Gross-total resection was achieved in 100% of these patients. All patients needed a complete hormone replacement therapy after surgery. Two patients (40%) had a significative increase in body mass index. Visual function was stable or improved in 80%. We had no cases of cerebrospinal fluid leak. One patient underwent proton therapy as an adjuvant treatment.

Conclusion: The endoscopic endonasal transsphenoidal approach is feasible and suitable for removing pediatric craniopharyngiomas even in young children with suprasellar tumors, with solid components and conchal sphenoid sinus.

Publication History

Article published online:
07 February 2025