Endoscopic Endonasal Transsphenoidal Surgery for of Pediatric Sellar Lesions (Pituitary Neuroendocrine Tumors and Rathke's Cleft Cysts): Radiographic and Biochemical Outcomes from a Single-Center Series

Introduction: Pituitary neuroendocrine tumors (PitNETs) and Rathkes Cleft cysts (RCC) in children are rare and distinct from more common pediatric sellar lesions such as craniopharyngioma. Presentation is often due to endocrinopathies or visual dysfunction secondary to optic chiasm compression. Surgical resection and perioperative management can be challenging, especially in young children. Objective: To assess the clinical, radiographic, endocrinologic, and vision outcomes of endoscopic endonasal surgery for PitNETs and RCCs in pediatric patients. Methods: An IRB-approved single center retrospective cohort study of pediatric patients undergoing endoscopic endonasal transsphenoidal surgery for PitNET between 2012 and 2025 was performed. Patient demographics, radiographic, endocrine, surgical, visual, and perioperative outcomes were obtained from the electronic medical record. Descriptive statistics were used for analysis. Results: A total of 29 patients were included for study. The average age was 16.0 ± 3.0 years and a total of 11(38%) patients were female. A total of 20 (69.0%) patients had functional PitNETs while 3 (10.3%) had nonfunctional PitNETs and 6 had RCC (20.7%). Of functional PitNETs, 8 (40%) were prolactinomas, 6 (30%) were ACTH-secreting, and 6 (30%) were growth hormone-secreting tumors. In total, 76% of patients presented with biochemical evidence of endocrinopathy of at least one axis and 17% presented with visual field deficits. Of functional PitNETs, biochemical remission was obtained in 85% of cases with surgery alone. Biochemical remission from surgery alone at time of last follow-up was seen in 8 (100%) of patients with prolactinoma, 4 (66.7%) patients with acromegaly, and 5 (83.3%) patients with Cushing’s disease over a median follow up of 44.5 months. Of nonfunctional PitNETs, complete resection was obtained in 66.7% of cases. RCCs were successfully decompressed in all cases. Postoperative temporary endocrinopathies were seen in 45% of surgically treated functional PitNETs, 66.7% of nonfunctional PitNETs, and 83.3% of RCCs. Permanent endocrinopathy was seen in 3.4% of cases. Preoperative visual dysfunction improved in 80% of affected children. The overall postoperative CSF leak rate was 13%. Conclusion: PitNETs and RCCs are rare in the pediatric population and display distinct endocrinologic and clinical outcomes as compared to more morbid pathology, such as craniopharyngioma. Endoscopic endonasal surgery is safe and should be considered as first line therapy, especially for functional PitNETs and nonfunctional PitNETs/RCCs with mass effect on the optic chiasm in centers with experienced multidisciplinary skull base teams. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany