title: Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgery.
abstract: BACKGROUND
  The practice of endoscopic endonasal surgery is still limited in children because of the relative rarity of sellar lesions in the paediatric population. However, such an approach is increasingly reported in the literature as an alternative option to standard sublabial microsurgery, and its surgical results are being analysed. No information on the trend of the postoperative course is currently available. The goal of this paper is to assess the impact of these two different transsphenoidal approaches on the postoperative course.
  
  
  METHODS
  Thirty-one consecutive paediatric patients were treated for sellar region lesions by transsphenoidal surgery. Fourteen children (group A) underwent surgery with a microsurgical sublabial transsphenoidal approach between 2000 and 2005; the remaining 17 children (group B) underwent surgery with an endoscopic endonasal transsphenoidal approach between 2005 and 2009. The two groups were compared as to rate of admission to the PICU, relief from preoperative symptoms, early surgical complications, postoperative pain (Wong-Baker FACES Pain Scale) and length of postoperative hospital stay.
  
  
  RESULTS
  Children in group B showed decreased rates of admission to the PICU (35% versus 100%) and peroperative blood transfusions (23% versus 71%), and a shorter mean postoperative hospital stay (4 days versus 5.7 days). The pain perception was significantly lower in group B than in group A, as demonstrated by the scores registered during both the early (2.05 ± 0.74 versus 2.92 ± 0.91) and late postoperative period (0.82 ± 0.95 versus 1.64 ± 0.84). No remarkable differences in terms of operative time, symptom improvement and early complications were detected.
  
  
  CONCLUSIONS
  Endoscopic endonasal surgery can improve the quality of the postoperative course in children regardless of the type of lesions treated and the surgical complications.
authors.affiliation: Paediatric Neurosurgery, A. Gemelli Hospital, Rome, Italy. lmassimi@email.it
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.forename: Mario
authors.initials: M
authors.lastname: Rigante
authors.forename: Luca
authors.initials: L
authors.lastname: D'Angelo
authors.forename: Giovanna
authors.initials: G
authors.lastname: Paternoster
authors.forename: Paola
authors.initials: P
authors.lastname: Leonardi
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paludetti
authors.forename: Concezio
authors.initials: C
authors.lastname: Di Rocco
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008046:Lip / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis; D010343:Patient Admission / Q000706:statistics & numerical data; D010900:Pituitary Diseases / Q000175:diagnosis / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*; D019291:Skull Base / Q000601:surgery*