Trends in Postoperative Imaging following Endoscopic Endonasal Skull Base Surgery for Pediatric Sellar Masses

Background: Inpatient postoperative imaging, including magnetic resonance imaging (MRI) and computed tomography (CT), following endoscopic endonasal skull base surgery is common. CT scans are often less preferred to MRI, despite their rapidity obviating the need for anesthesia in the pediatric population due to high radiation doses. The purpose of this study is to analyze imaging patterns and trends following endoscopic endonasal resection of pediatric sellar masses.

Methods: The 2015–2022 Pediatric Health Information System (PHIS) database was queried for pediatric patients diagnosed with sellar masses, including pituitary adenoma, craniopharyngioma, and other lesions. Patients were then classified as receiving early inpatient MRI, CT, or no imaging.

Results: A total of 507 patients (49.9% female) less than 18 years of age underwent endoscopic endonasal resection of a sellar mass. Postoperative CT imaging was obtained in 79 (15.6%) cases, postoperative MRI was obtained in 280 (55.2%) cases and 148 (29.2%) cases were observed clinically. Patients who underwent CT imaging were typically younger (11.9 ± 3.7 years) than patients who had MRI (12.0 ± 4.32 years) or no imaging (13.5 ± 3.7 years), p < 0.001. Craniopharyngiomas were more likely to be imaged postoperatively (174/199, 87.4%) compared with pituitary adenomas (133/233, 57.1%) and other sellar masses (52/75, 69.3%), p < 0.001. Patient insurance (p = 0.052) and family income (p = 0.67) did not significantly impact which postoperative imaging modality was obtained. Temporal analysis demonstrated no significant change in obtaining postoperative CT (R² = 0.015 p = 0.77) or MRI (R² = 0.003 p = 0.89) over the study period.

Conclusion: Postoperative imaging is common following endoscopic endonasal resection of sellar masses. CT imaging is more frequently obtained for younger patients, and for patients with craniopharyngiomas, likely due to need for sedation for MRI in the very young population. Temporal analysis demonstrated no change in utilization of postoperative imaging ([Fig. 1]).

Fig. 1 Trends in postoperative CT vs. MRI over time. There is no significant change in utilization of postoperative CT (R² = 0.015 p = 0.77) or postoperative MRI (R² = 0.003 p = 0.89) over the study period following endoscopic endonasal skull base surgery for pediatric sellar masses.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
01 February 2023