Endoscopic transsphenoidal approach versusmicroscopic approach in children Mario Rigante a, * , Luca Massimi b , Claudio Parrilla a , Jacopo Galli a , Massimo Caldarelli b , ConcezioDi Rocco b , Gaetano Paludetti a a Institute of Otolaryngology, A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome00168, Italy b Pediatric Neurosurgery, A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy 1. Introduction The wide experienceand diffusion of endoscopicendonasal approaches to the anteriorskull basein adultsis not the samethat in pediatric population [1]. Only a few clinical studies, usually limited to small and/ormixedseries, areavailable in the literature [2–4] and the resultsof thesestudiesare generally focused on the surgical outcomes and feasibility of such technique also in children. The main causes of such a behavior are the relative rarity of sellar and parasellar lesions in children and their unfavorable anatomical characteristics(small nostrils, narrow nasal cavities, reduced/absent pneumatizationof the sphenoid sinus)other than the lack of a dedicated surgical instrumentation. Actually, although traditionallyconsidered to startfrom the 3rd to 4th year of ageand to be completed during the seconddecade of life [5,6], several studiesbased on anatomical, CT and MR imaging demonstrated that the sphenoid pneumatization begins asearlyas the first month of ageand usually finisheswithin the first decade [7,8]. A correct preoperative radiological assessment, which should include the nose and the paranasal sinuses, and the use of neuronavigation make it safe to manage such anatomical variations. Recently thanksto the increasing experience in adults and developmentof some surgical devices such as the small- diameter nasal endoscopes, new smaller instruments, combined with image guidance systems, the range of application of endoscopic transnasal surgery (ETS)in childrenhasbecome wider also amongpediatricneurosurgeons. The aim of the presentstudy is to report on the effectsof ETS compared with the conventional microscopic trans-sphenoidal surgery (CTS) in a seriesof pediatricpatients affected by sellarand parasellar lesionsin termsof surgical andfunctional resultbut also evaluating the impact of this kind of approaches on the quality of the postoperative courseand the clinical outcome. International Journal of PediatricOtorhinolaryngology 75 (2011) 1132–1136 A R T I C L E I N F O Articlehistory: Received 28 April 2011 Received in revisedform 2 June 2011 Accepted 9 June 2011 Availableonline 16 July 2011 Keywords: Pituitary surgery Endoscopic transsphenoidal surgery Sellar parasellar lesion in children A B S T R A C T Objectives: To confirm the efficacy and safenessof the endoscopicendonasaltranssphenoidal (ETS) approachin the treatment of sellar and parasellar lesions in children comparedwith the conventional microscopictranssphenoidal approach(CTS). Studydesign:Caseserieswith chart review. Setting:A. Gemelli – University Hospital – Catholic University of SacredHeart – Rome. Subject and methods: We retrospectively evaluate21 children (meanage8.3 years)affectedby sellar/ parasellar lesions: 11 were treatedvia microscopicsublabialapproachbetween1995 and 2005 and 10 were treatedwith ETS approachbetween2006 and 2009. Results:The past series(group A) comprisedall sellar/suprasellar lesionsand we observed: grosstotal surgical excisionin 81.2% of cases, permanent morbidity in 1/11 patients,CSFfistula in 1/11 patients, meanhospitalizationtime of 5.8 days and PICU was required.The presentseries(group B) included 8 sellar/suprasellar and 2 clival lesionsand we observed: GTSexcisionin 80%of the cases, no permanent morbidity, a meanhospitalizationtime of 4.1 days(P =0.01),CSFfistula in 2/10 patientsand the PICU was not required. 10/11 patient of group A underwent to blood transfusion vs 4/10 of the group B (P =0.008). The meanpain scoreof group A was 5.8 1.7 on the contraryin the groupB it was 4.1 1.5 (P =0.006). Conclusion: The ETS approach to the sellar and parasellar region has proved its reliability and effectiveness in the adults.Theminimal invasiveness makes it ideal for the treatment of pediatriclesion of this region,in which it is essential to preserve the integrityof the hypothalamic-pituitary axis and of the naso-facialstructuresto assurethe correctgrowth of the child. ß 2011 ElsevierIreland Ltd. All rights reserved. * Corresponding author.Tel.: +390630154439; fax: +39063051194; mobile: +393284177206. E-mail addresses: m_rigante@hotmail.com, rigam@inwind.it (M. Rigante). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology j ou r n a l ho mep a g e : ww w . e l s e v i e r . c om / l o c a t e / i j p o r l 0165-5876/$ – seefront matterß 2011 ElsevierIreland Ltd. All rights reserved. doi:10.1016/j.ijporl.2011.06.004