Approaching the Sella through the Nonpneumatized Sphenoid in Pediatric Patients

Object: The purpose of this study was to assess the complications and outcomes of the transsellar approach for skull base tumor resection in nonpneumatized sphenoid sinuses.

Method: Data were collected by a retrospective chart review done on children ages 7 years and under who underwent endoscopic tumor resection and had partially or completely nonpneumatized sphenoid sinus on preoperative computed tomography (CT) imaging. Surgical data collected included surgical corridor, gross-total versus subtotal resection, repair method, use of septal flap, intraoperative and postoperative cerebrospinal fluid leak, and estimated blood loss.

Results: Four patients were identified that fit our inclusion criteria who underwent surgery between November 2015 and April 2018 (2 males, 2 females; average age = 3.175 years). Tumor pathologies include two craniopharyngiomas, Rathke’s cleft cyst, and meningocele. All four cases involved varying percentages of sphenoid sinus pneumatization and required removal of cancellous bone to access the pathology. All four patients had significant blood loss intraoperatively. The two older patients, lost 3.49 and 4.06% of total blood volume. The two youngest patients, 13 and 5 months, with completely nonpneumatized sphenoids lost 17.52 and 61.73% total blood volume, respectively, and both required intraoperative blood transfusions.

Conclusion: Intraoperative challenges including hemorrhage are likely in nonpneumatized patients, and thus surgeons should be prepared with adequate vascular access and blood products. Hemorrhage and total blood volume loss is increased in the younger patients with no sphenoid pneumatization. Despite the additional challenges, a nonpneumatized sphenoid sinus is not a contraindication for an endoscopic resection in the pediatric population.