Clinical characteristics, surgical and endocrinological outcomes of sellar and parasellar masses in pediatric patients: a single-center experience.

Purpose: To evaluate the clinical characteristics, surgical outcomes, and endocrinological follow-up findings of pediatric patients who underwent surgical treatment for sellar and parasellar masses.

Methods: Forty-seven patients who underwent surgical treatment for sellar and parasellar masses between January 2021 and January 2025 were retrospectively analyzed. All patients were followed up in the pediatric endocrinology clinic. Demographic characteristics, clinical findings, surgical approaches, histopathological diagnoses, and postoperative outcomes were evaluated. Endocrinological assessments were performed using standardized hormone assays with age- and sex-specific reference ranges.

Results: Twenty-eight (59.6%) patients were female, with a median age of 10.1 years (range: 2.5-17.5). The most common presenting complaint was headache (46.8%), followed by visual impairment (27.7%) and short stature (14.9%). Histopathological examination revealed non-pituitary masses in 35 (74.5%) patients, with craniopharyngioma being the most frequent (44.7%). An endoscopic approach was used in 42 (89.4%) patients, and total resection was achieved in 30 (63.8%) patients. Panhypopituitarism developed in 27 (57.4%) patients postoperatively, representing a significant increase from preoperative rates (10.6%, p < 0.001). During a median follow-up of 2.5 years, recurrence occurred in 10 (21.3%) patients and mortality in 11 (23.4%) patients. Patients with non-pituitary tumors had significantly higher rates of re-operation (37.1% vs. 0%, p = 0.012) and mortality (31.4% vs. 0%, p = 0.024) compared to those with pituitary tumors.

Conclusions: Surgical management of pediatric sellar and parasellar masses carries significant risk of endocrinological complications, particularly panhypopituitarism. A multidisciplinary approach combining appropriate surgical technique selection, comprehensive endocrinological evaluation, and long-term follow-up is essential for optimal patient outcomes. Non-pituitary masses, especially craniopharyngioma, are associated with higher morbidity and mortality rates.