Microscopic Trans-sphenoidal surgery in paediatric pituitary adenoma: An institutional experience

Abstract

Introduction : Pituitary adenoma is common in adult population but rare in pediatric population. Microscopic transnasal trans-sphenoidal surgery (MTTS) is gold standard technique for this. In the last two decades, there is increasing trend for endoscopic trans-sphenoidal surgery for pituitary adenoma. Endoscopic surgery had many well-established benefits over microscopic surgery in case of adult patients. But many surgeons are not fond of using endoscope in pediatric patients because of limited space in children. There is difficulty in maneuvering the endoscope in small nostrils. Present study showed that MTTS is safe and easy procedure in pediatric pituitary adenoma patients. Materials and Methods : All pediatric patients operated by MTTS technique in single institute by a single neurosurgeon during 2010–2018 were analyzed retrospectively. All patients were below 18 years of age. Data were collected from bed head ticket, operative notes, and discharge summary and histological records. Results : Total 22 patients were included in the study. The mean age was 14 years ranging from 11 to 17 years. Symptoms were as follows: headache in 46%, menstrual irregularity in 36%, visual disturbance in 32%, feature of acromegaly in 14%, and features of Cushing disease in 23%. Functioning adenoma was found in 20 patients (91%). Among functioning adenoma, prolactinoma comprises 55%, adrenocorticotropic hormone secretary tumors 22%, growth hormone secretary tumor 14%, and nonfunctioning adenoma 9%. Majority of tumors extending to suprasellar area were prolactinoma (75%). Gross total resection was achieved in 18 cases (82%). Four patients (18%) had postoperative cerebrospinal fluid leak and all these patients were having macroadenoma or giant adenoma. Hormonal profile became normal in 16 patients (80%) out of 20 functioning tumors postoperatively. Seventy-eight percent female patients (seven patients) had improvement in their menstrual irregularity. Transient diabetes insipidus dev