• Diego Mazzatenta, Matteo Zoli, Federica Guaraldi, Francesca Ambrosi, Faustini Fustini Marco M Center for Diagnosis and Treatment of Pituitary and Skull Base Tumors (Pituitary Unit), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bol, Ernesto Pasquini, Sofia Asioli, and Mino Zucchelli.
• Center for Diagnosis and Treatment of Pituitary and Skull Base Tumors (Pituitary Unit), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
• World Neurosurg. 2020 Feb 1; 134: e277-e288.

BackgroundIn the last years, few reports have shown the feasibility of the endoscopic endonasal approach (EEA) for craniopharyngiomas in pediatric patients. For these tumors, recent studies have suggested less aggressive surgery, favoring the preservation of the patient's quality of life.ObjectiveThe aim of this study was to assess the outcome of the EEA in a large series with specific attention on the long-term functional sequelae.MaterialsAll consecutive pediatric craniopharyngiomas operated on through this approach since 2000 were included in the study. Preoperative and postoperative operative clinical, radiologic, and pathologic features were retrieved from patient records (mean follow-up, 72 ± 67 months).ResultsThe series included 25 patients (12 female; mean age, 8.9 ± 4.1 years). Most of the tumors presented with a supradiaphragmatic extension (88%). Removal was radical in 23 patients (92%). Complications consisted of 6 cerebrospinal fluid leaks (24%). One patient (4%) died of postoperative respiratory complications. Most patients (92%) developed panhypopituitarism and visual disturbances normalized or improved in 6 patients (43%). At follow-up, 9 patients (36%) were overweight/obese (6 were already overweight before surgery). The tumor recurrence rate was 19%.ConclusionsEEA can be an effective approach for midline craniopharyngiomas in children older than 3 years. It gives a satisfactory exposure of the suprasellar region and an adequate assessment of the brain-tumor interface. Its main limitations are age-related anatomic features of nasal/paranasal sinuses and the risk of cerebrospinal fluid leak.Copyright © 2019 Elsevier Inc. All rights reserved.

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