Second-stage transsphenoidal approach (TSA) for highly vascular pituicytomas in children

Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery
Young Gyu Kim, Young Seok Park

Abstract

A pituicytoma in the sellar area is extremely rare in children and, due to its highly vascularized nature, can be difficult to address using the transsphenoid approach (TSA) to surgery. Here, we report a rare case of a pituicytoma that was completely removed from a child through a staged operation using the TSA. A 13-year-old girl was admitted with a 1-year history of visual disturbance and amenorrhea. Visual field examination showed left total blindness and right temporal hemianopsia. Laboratory results revealed hormonal levels all within normal ranges. Brain magnetic resonance imaging (MRI) showed a homogeneous, highly enhancing sellar and suprasellar mass, typically suggestive of a pituitary adenoma. TSA surgery revealed the tumor had a rubbery-firm consistency, hypervascularity, and profuse bleeding. We removed the tumor partially and planned a second-stage operation. Gross total removal is the treatment of choice for this type of tumor. Attempted resection of these presumed adenomas or meningiomas using the TSA often results in unexpectedly heavy intraoperative bleeding due to the high vascularity of this rare tumor, making surgery challenging, especially in children where the tumor is within a relatively narrow corridor. ...Continue Reading

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Citations

Dec 1, 2017·Brain Tumor Research and Treatment·Hyuk Ki ShimSung-Hye Park
Jul 22, 2018·Journal of Endocrinological Investigation·F J Salge-ArrietaL Ley-Urzáiz
Mar 14, 2019·Reviews in Endocrine & Metabolic Disorders·Fernando Guerrero-PérezCarles Villabona
Aug 1, 2018·Pituitary·Etienne LefevreAnne-Laure Boch
May 11, 2021·Clinical Neurology and Neurosurgery·Baoshi ChenZhong Zhang

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