Transsphenoidal approach in children with partially or minimally developed sphenoid sinus.

ABSTRACT

OBJECT The transsphenoidal approach is guided by a few fundamental anatomic landmarks. Pneumatization of the SS is variable, and this plays a key role in accessing the sella floor and other skull base structures. It may be absent or minimally present in both adult and, often, pediatric population, making surgical approach more difficult than usual. We aim to demonstrate that also in the more difficult cases, with a minimal level of pneumatization, the transsphenoidal approach is still possible especially with the support of neuronavigation and intraoperative magnetic resonance imaging (iMRI). METHODS: We present our experience accumulated after the treatment of 6 children with minimally pneumatized sphenoid sinus describing the workflow to access the sella floor. RESULTS: No perioperative complications due to the surgical approach were observed, and no cases of mortality were reported. After the surgery, the visual field deficit improved in 1 patient and remained stable in three patients. No postoperative new neurologic deficits were found. No cases of cerebrospinal fluid (CSF) leak were observed. CONCLUSIONS: The transsphenoidal approach can be safely used even in cases of minimally or even absent pneumatization of SS as in young children. In order to have a safe approach in such patients, the use of tools, such as navigation system and iMRI, is recommended. Furthermore, the iMRI allows to avoid exposure to radiation as in case of fluoroscopy.