Pediatric transseptal transsphenoidal pituitary surgery

The use of the transseptual transsphenoidal approach to the pituitary gland has gained acceptance as a safe, relatively atraumatic means of removing p ituitary tumors. The outcome in adult patients has been successful; however , the outcome in pediatric patients whose noses may still be developing is not well described. We reviewed the outcomes in 41 patients younger than ag e 18 years who underwent transseptual transsphenoidal pituitary surgery at our institution between 1986 and 1997 (20 boys and 21 girls; age 3 to 17 ye ars; mean age, 13,4 years). The most common diagnosis was prolactin-secreti ng adenoma (14 patients), followed by craniopharyngioma (7 patients). Prese nting symptoms including headache (20 patients), galactorrhea (13 patients) , and menstrual irregularities (11 patients). The most common early complic ation was transient diabetes insipidus (20 patients). No patient experience d serious bleeding at pack removal and no patient developed a cerebrospinal fluid leak postoperatively. Follow-up ranged from 3 months to 12.7 years, with 7 patients experiencing recurrent or residual disease between 6 days a nd 2 years after their original transseptual procedure. The most common lon g-term surgical complication was nasal obstruction in 5 patients, 3 of whom also complained of seasonal allergies. Four patients complained of recurre nt sinus infections, and 4 patients noted an external nasal deformity as a result of the surgery.