Transsphenoidal Approaches for Microsurgical Resection of Pituitary Adenomas in Pediatric Patients.

Objective: Pituitary adenomas are uncommon in the pediatric population. Although medical treatment can be effective in treating prolactinomas and some growth hormone-secreting tumors, resection is indicated in the setting of pituitary apoplexy, large or giant pituitary adenomas causing mass effect or visual loss, or when medical therapy becomes ineffective or intolerable. Modern microsurgical transsphenoidal approaches are potential avenues for resection in pediatric patients. We evaluated the outcomes and safety of this approach.

Methods: A retrospective cohort analysis was performed from February 2002 through May 2017 for patients younger than 19 years of age that underwent a transsphenoidal approach for pituitary adenoma resection.

Results: Among a total of 634 patients who underwent transsphenoidal approach for pituitary adenoma resection, 24 pediatric cases were identified. Prolactinomas (29.2%) and adrenocorticotropic hormone-secreting (20.8%) pituitary adenomas were the most commonly encountered histologies. Gross total resection was achieved in 75.0% of patients, and complete hormone function normalization was seen in 91.7% of patients. Eight patients (33.3%) required postoperative hormone replacement therapy. Twelve patients (50.0%) underwent fat/fascia use and 1 patient (4.2%) underwent lumbar puncture perioperatively for management of cerebrospinal fluid leak. There were no tumor recurrences during a follow-up period of 24.7 ± 32.1 months.

Conclusions: A modern transsphenoidal microsurgical approach proved to be a safe, well-tolerated, and effective modality in the setting of pediatric pituitary adenomas.