Received: 3 January 2000 Abstract The endoscopic endonasal transsphenoidal approach to the sell- ar region for the removal of pituitary adenomas and of other neoplasms in the same area has proved its reliabil- ity and effectiveness for the very wide vision it offers, coupled with minimal surgical trauma. Indications and advantages of such a technique are reported, focused on the treat- ment of lesions of the sellar and parasellar environment in pediatric age-group patients, and based on a consecutive series of 100 patients, 3 of them adolescents, treated during the last 3 years. Keywords Endoscopy · Pediatric brain tumors · Pituitary adenoma · Transsphenoidal surgery Child’s Nerv Syst (2000) 16:692–696 © Springer-Verlag 2000 ORIGINAL PAPER Enrico de Divitiis Paolo Cappabianca Michelangelo Gangemi Luigi Maria Cavallo The role of the endoscopic transsphenoidal approach in pediatric neurosurgery Introduction The history of transsphenoidal surgery for sellar- region lesions [42] begins in the early 1900s when Schoffler, following a study on the cadaver by the Italian, Giordano [4, 19], chief surgeon of the Venice Hospital, performed through a superolateral nasoeth- moidal route the first extracranial transsphenoidal re- moval of a pituitary adenoma. After a few years this procedure was better standardized by Cushing and Hirsch who proposed respectively, an oronasal and an inferior endonasal approach. During that century the transsphenoidal technique more than once was about to fall into disuse in favor of transcranial ones (pterional, subfrontal, subtemporal), more invasive, but then capa- ble of offering a major view of the surgical field and a better surgical management. Later, two significant im- provements to the transsphenoidal approach, made by Guiot, with the use of intraoperative fluoroscopic con- trol, and by Hardy, utilizing a surgical microscope, fa- vored a better view of the surgical field and a safer ori- entation, fixing the definite affirmation of the technique, generally acknowledged as first choice in almost all sellar lesions. Moreover, in the past few years, endo- scopic procedures have gained ground in neurosurgery, both as techniques combined with microsurgery (endo- scope-assisted microneurosurgery), and as autonomous surgical options (pure endoscopy). The latter, added to the contribution of the otorhinolaryngologists in the sur- gery of the paranasal sinuses with functional endoscopic sinus surgery (FESS) [39, 40, 49, 59, 60, 61] has en- couraged a series of attempts at pituitary endoscopic transsphenoidal adenomectomy, endonasal [24, 25] or transnasal [18, 24, 29, 54, 55, 57, 66], unilateral [24, 25] or bilateral [12, 52], endoscope-assisted [14, 16, 18, 22, 25, 26, 41, 45, 48, 58, 67] or purely endoscopic [25, 29, 54, 57, 66], up to the present adjustment of an endo- scopic endonasal unilateral transsphenoidal approach by Jho [11, 32, 33, 34, 35, 37]. Jho has made this procedure simple, less traumatic, very effective, and capable of al- lowing a more extensive surgical removal, respecting the anatomic structures running through. Paper presented at the World Conference on Pediatric Neurosurgery, 2000 A.D.: State of the Art and Perspectives for the Third Millennium, Martinique, 27 November to 4 December 1999 E. de Divitiis · P. Cappabianca ( ✉ ) M. Gangemi · L.M. Cavallo Department of Neurosurgery, “Federico II” University, Via S. Pansini, 5, 80131 Naples, Italy e-mail: cappabia@unina.it Tel.: +39-081-7462583 or 7462582 Fax: +39-081-5987821 or 7462497