Endoscopic transnasal surgery for pituitary neuroendocrine tumors (Pit-NETs) in children and young adolescents (CYP) - clinical profile, outcomes and sino-nasal quality of life - an Institutional Experience.
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OBJECTIVES: Pituitary neuroendocrine tumors (PitNETs) are rare in children and young adolescents under the age of 19 years (referred to as CYP). This study describes our experience with endoscopic transnasal management of these tumors at a tertiary neurosurgical center over a 15-year period. METHODS: This was a retrospective cohort study of patients aged less than 19 years of age, with PitNETs diagnosed at our center and managed with endoscopic transnasal transsphenoidal resection surgery between January 2010 and December 2024. Demographic and clinicopathological data, surgical details, adjuvant therapy, hormonal and visual evaluation, and follow-up details were reviewed. The SN-5 questionnaire was used to assess the sinonasal quality of life. RESULTS: A total of 19 patients were enrolled, with a mean age of 15.05 years, and a male-to-female ratio of 1.4:1. The most common presenting symptoms were headache in 84% and progressive diminution of vision in 47% of patients. Seventeen patients had functioning adenomas, the most common being GH-secreting adenomas (8). The median volume of the lesions was 9.53 cc, with 15 macroadenomas and four microadenomas, with gross total resection achieved in 47.4% and near total resection in 31.6%. Complications included diabetes insipidus (5), CSF rhinorrhea resolving with temporary CSF diversion (6), and pituitary insufficiency requiring long-term hormone supplementation (8). Over a median follow-up period of 24.68 months (range 10.5-68.1 months), visual acuity improved in 87.5% patients, while 70.6% of patients with functioning adenomas achieved endocrinological remission at the last follow-up. CONCLUSIONS: Our experience reinforces the utility of endoscopic transnasal procedures in the pediatric and young-adolescent age group, achieving satisfactory clinical outcomes regarding vision and endocrinological status, which is especially important due to the dominance of functioning adenomas in this age group.