Endonasal approaches to the sellar and parasellar regions: Closure techniques using biomaterials

Purpose: We reviewed the clinical outcomes resulting from various closure techniques used following endoscopic endonasal surgery for lesions in the sellar and parasellar regions. We compared our current closure technique, which uses a biological matrix of native equine collagen (TissuDura) fixed with fibrin sealant (Tisseel), with the technique we employed previously, using autologous materials, in order to assess the comparative efficacy and tolerability of both methods over the medium- to long-term. Methods: A review was conducted of all cases of endonasal endoscopic intervention carried out in our institution between 1997 and 2007. Operations performed between January 1st 1997 and December 31st 2003 involved a sellar closure technique using autologous materials, either alone or supported by fibrin sealant. From January 1st 2004, sellar reconstruction techniques involving resorbable heterologous materials were used in the closure phases. Post-operatively, clinico-endoscopic assessments took place at 15 days, 1, 3, and 6 months and yearly thereafter, supplemented by magnetic resonance imaging (MRI) scanning at 3 months and annually. Results: Between January 1st 1997 and December 31st 2003, 79 operations were performed in which the sellar closure technique involved the use of autologous materials. Between January 1st 2004 and January 1st 2008, 125 operations were performed in which biomaterials were used for sellar closure. The incidence of complications (fluid fistula) was 2.5% in the autologous materials closure group and 1.6% in the biomaterials closure group. The most marked difference between the two approaches was seen at 1-month follow-up, when restoration of mucociliary transport in the sphenoidal sinus and physiological functionality of the nasal mucosa and paranasal sinuses were observed to be superior in the biomaterials patient cohort. Conclusions: The development of biomaterials for closure of the sellar floor offers a viable alternative to traditional techniques using autologous materials. \ua9 2009 Springer-Verlag

Endoscopic endonasal transsphenoidal surgery for sellar tumors in children

OBJECTIVE: Endoscopic endonasal transsphenoidal surgery (EETS) is still rarely used in pediatric subjects compared with adults. Reports on EETS in children appeared only recently in the literature, usually regarding small series. The aim of the study is to assess the actual role and the limits of EETS in children with sellar tumors by reporting a two-centers experience. METHODS: Twenty-seven children (mean age: 12.2 years) were operated on during the last decade. Seventeen patients harbored a sellar mass, 7 a suprasellar tumor, and 3 a clival mass. Laboratory investigations revealed hypopituitarism in 6 children and hormone hypersecretion in 9. All the operations were carried out by a team including both ENT surgeon and neurosurgeon using a dedicated 18-cm long rigid endoscope (2.7 mm and 4 mm diameter) through the direct paraseptal or the transethmoidal or the transpterygoid route. RESULTS: Overall, 29 operations were performed. Gross total tumor resection was obtained in 22 children (81.5%) while a subtotal and a partial removal in 2 (7.5%) and 3 cases (11%), respectively. Pituitary adenoma was the most common histotype (12 cases), followed by craniopharyngioma (5) and Rathke's cleft cyst (4). No surgical mortality or neurological morbidity or late nasal complications were observed. Postoperative CSF fistula occurred in 3 patients. All children are alive at current follow-up (average: 8.6 years). Preoperative hypopituitarism disappeared or improved in 4 cases and was stable in the remaining 2 (no new hormone deficits appeared). CONCLUSION: EETS is a safe and effective surgical option also in children. As for adults, it allows to manage most of the tumor lesions of the sellar region with stable long-term results