Pediatric pituitary adenomas

  • Patrick C. WalzEmail author
  • Annie Drapeau
  • Ammar Shaikhouni
  • Jacob Eide
  • Alex J. Rugino
  • Ahmed Mohyeldin
  • Ricardo Carrau
  • Daniel Prevedello
Focus Session



Pediatric pituitary adenomas are a rare medical entity that makes up a small portion of intracranial tumors in children and adolescents. Although benign, the majority of these lesions are secreting functional tumors with the potential for physiological sequela that can profoundly affect a child’s development.

Focus of Review

In this review, we discuss the medical and surgical management of these tumors with a focus on clinical presentation, diagnostic identification, surgical approach, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to treat these tumors.


The management of pituitary tumors requires a multidisciplinary team of surgeons, endocrinologists, and neuroanesthesiologists as well as neurocritical care specialists to deliver comprehensive care.


Skull base Pediatric Endonasal Pituitary adenoma 


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Espay AJ, Azzarelli B, Williams LS, Bodensteiner JB (2001) Recurrence in pituitary adenomas in childhood and adolescence. J Child Neurol 16(5):364–367Google Scholar
  2. 2.
    Mindermann T, Wilson CB (1995) Pediatric pituitary adenomas. Neurosurgery. 36(2):259–268 discussion 269Google Scholar
  3. 3.
    Laws ER, Scheithauer BW, Groover RV (1987) Pituitary adenomas in childhood and adolescence. Prog Exp Tumor Res 30:359–361Google Scholar
  4. 4.
    Rosemberg S, Fujiwara D (2005) Epidemiology of pediatric tumors of the nervous system according to the WHO 2000 classification: a report of 1,195 cases from a single institution. Childs Nerv Syst 21(11):940–944Google Scholar
  5. 5.
    Barzaghi LR, Losa M, Capitanio JF, Albano L, Weber G, Mortini P (2018) Pediatric pituitary adenomas: early and long-term surgical outcome in a series of 85 consecutive patients. Neurosurgery.Google Scholar
  6. 6.
    Perry A, Graffeo CS, Marcellino C, Pollock BE, Wetjen NM, Meyer FB (2018) Pediatric pituitary adenoma: case series, review of the literature, and a skull base treatment paradigm. J Neurol Surg B Skull Base 79(1):91–114Google Scholar
  7. 7.
    Dyer EH, Civit T, Visot A, Delalande O, Derome P (1994) Transsphenoidal surgery for pituitary adenomas in children. Neurosurgery. 34(2):207–212 discussion 212Google Scholar
  8. 8.
    Lafferty AR, Chrousos GP (1999) Pituitary tumors in children and adolescents. J Clin Endocrinol Metab 84(12):4317–4323Google Scholar
  9. 9.
    Kunwar S, Wilson CB (1999) Pediatric pituitary adenomas. J Clin Endocrinol Metab 84(12):4385–4389Google Scholar
  10. 10.
    Keil MF, Stratakis CA (2008) Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics. Expert Rev Neurother 8(4):563–574Google Scholar
  11. 11.
    Camper SA (2011) Beta-catenin stimulates pituitary stem cells to form aggressive tumors. Proc Natl Acad Sci U S A 108(28):11303–11304Google Scholar
  12. 12.
    Harrington MH, Casella SJ (2012) Pituitary tumors in childhood. Curr Opin Endocrinol Diabetes Obes 19(1):63–67Google Scholar
  13. 13.
    Mehta A, Dattani MT (2008) Developmental disorders of the hypothalamus and pituitary gland associated with congenital hypopituitarism. Best Pract Res Clin Endocrinol Metab 22(1):191–206Google Scholar
  14. 14.
    Kioussi C, O’Connell S, St-Onge L, Treier M, Gleiberman AS, Gruss P, Rosenfeld MG (1999) Pax6 is essential for establishing ventral-dorsal cell boundaries in pituitary gland development. Proc Natl Acad Sci U S A 96(25):14378–14382Google Scholar
  15. 15.
    Shaid M, Korbonits M (2017) Genetics of pituitary adenomas. Neurol India 65(3):577–587Google Scholar
  16. 16.
    Colao A, Loche S, Cappa M, di Sarno A, Landi ML, Sarnacchiaro F, Facciolli G, Lombardi G (1998) Prolactinomas in children and adolescents. Clinical presentation and long-term follow-up. J Clin Endocrinol Metab 83(8):2777–2780Google Scholar
  17. 17.
    Schlechte JA (2003) Clinical practice. Prolactinoma. N Engl J Med 349(21):2035–2041Google Scholar
  18. 18.
    Fideleff HL, Boquete HR, Sequera A, Suarez M, Sobrado P, Giaccio A (2000) Peripubertal prolactinomas: clinical presentation and long-term outcome with different therapeutic approaches. J Pediatr Endocrinol Metab 13(3):261–267Google Scholar
  19. 19.
    Joshi SM, Hewitt RJ, Storr HL et al (2005) Cushing’s disease in children and adolescents: 20 years of experience in a single neurosurgical center. Neurosurgery. 57(2):281–285 discussion 281-285Google Scholar
  20. 20.
    Lonser RR, Wind JJ, Nieman LK, Weil RJ, DeVroom HL, Oldfield EH (2013) Outcome of surgical treatment of 200 children with Cushing’s disease. J Clin Endocrinol Metab 98(3):892–901Google Scholar
  21. 21.
    Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler GB Jr, Nieman LK, Chrousos GP (1994) Cushing’s syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 331(10):629–636Google Scholar
  22. 22.
    Yordanova G, Martin L, Afshar F, Sabin I, Alusi G, Plowman NP, Riddoch F, Evanson J, Matson M, Grossman AB, Akker SA, Monson JP, Drake WM, Savage MO, Storr HL (2016) Long-term outcomes of children treated for Cushing’s disease: a single center experience. Pituitary. 19(6):612–624Google Scholar
  23. 23.
    Abe T, Tara LA, Ludecke DK (1999) Growth hormone-secreting pituitary adenomas in childhood and adolescence: features and results of transnasal surgery. Neurosurgery. 45(1):1–10Google Scholar
  24. 24.
    Brucker-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD (1999) Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 84(2):476–486Google Scholar
  25. 25.
    Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD (1996) Thyrotropin-secreting pituitary tumors. Endocr Rev 17(6):610–638Google Scholar
  26. 26.
    Kane LA, Leinung MC, Scheithauer BW et al (1994) Pituitary adenomas in childhood and adolescence. J Clin Endocrinol Metab 79(4):1135–1140Google Scholar
  27. 27.
    Partington MD, Davis DH, Laws ER Jr, Scheithauer BW (1994) Pituitary adenomas in childhood and adolescence. Results of transsphenoidal surgery. J Neurosurg 80(2):209–216Google Scholar
  28. 28.
    Webb C, Prayson RA (2008) Pediatric pituitary adenomas. Arch Pathol Lab Med 132(1):77–80Google Scholar
  29. 29.
    Jankowski PP, Crawford JR, Khanna P, Malicki DM, Ciacci JD, Levy ML (2015) Pituitary tumor apoplexy in adolescents. World Neurosurg 83(4):644–651Google Scholar
  30. 30.
    Mohr G, Hardy J (1982) Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol 18(3):181–189Google Scholar
  31. 31.
    Cardoso ER, Peterson EW (1984) Pituitary apoplexy: a review. Neurosurgery. 14(3):363–373Google Scholar
  32. 32.
    Chanson P, Lepeintre JF, Ducreux D (2004) Management of pituitary apoplexy. Expert Opin Pharmacother 5(6):1287–1298Google Scholar
  33. 33.
    Delman BN (2009) Imaging of pediatric pituitary abnormalities. Endocrinol Metab Clin N Am 38(4):673–698Google Scholar
  34. 34.
    Oldfield EH, Doppman JL, Nieman LK, Chrousos GP, Miller DL, Katz DA, Cutler GB Jr, Loriaux DL (1991) Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing’s syndrome. N Engl J Med 325(13):897–905Google Scholar
  35. 35.
    Zimmerman RA (1990) Imaging of intrasellar, suprasellar, and parasellar tumors. Semin Roentgenol 25(2):174–197Google Scholar
  36. 36.
    Arafah BM, Nekl KE, Gold RS, Selman WR (1995) Dynamics of prolactin secretion in patients with hypopituitarism and pituitary macroadenomas. J Clin Endocrinol Metab 80(12):3507–3512Google Scholar
  37. 37.
    Barkan AL, Chandler WF (1998) Giant pituitary prolactinoma with falsely low serum prolactin: the pitfall of the “high-dose hook effect”: case report. Neurosurgery. 42(4):913–915 discussion 915-916Google Scholar
  38. 38.
    Batista DL, Riar J, Keil M, Stratakis CA (2007) Diagnostic tests for children who are referred for the investigation of Cushing syndrome. Pediatrics. 120(3):e575–e586Google Scholar
  39. 39.
    Orth DN, DeBold CR, DeCherney GS et al (1982) Pituitary microadenomas causing Cushing’s disease respond to corticotropin-releasing factor. J Clin Endocrinol Metab 55(5):1017–1019Google Scholar
  40. 40.
    Kaltsas GA, Giannulis MG, Newell-Price JD et al (1999) A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 84(2):487–492Google Scholar
  41. 41.
    Stoffel-Wagner B, Springer W, Bidlingmaier F, Klingmuller D (1997) A comparison of different methods for diagnosing acromegaly. Clin Endocrinol 46(5):531–537Google Scholar
  42. 42.
    Carmichael JD, Bonert VS, Mirocha JM, Melmed S (2009) The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly. J Clin Endocrinol Metab 94(2):523–527Google Scholar
  43. 43.
    Cook DM, Ezzat S, Katznelson L, Kleinberg DL, Laws ER Jr, Nippoldt TB, Swearingen B, Vance ML, AACE Acromegaly Guidelines Task Force (2004) AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of acromegaly. Endocr Pract 10(3):213–225Google Scholar
  44. 44.
    Fideleff HL, Boquete HR, Suarez MG, Azaretzky M (2009) Prolactinoma in children and adolescents. Horm Res 72(4):197–205Google Scholar
  45. 45.
    De Menis E, Visentin A, Billeci D et al (2001) Pituitary adenomas in childhood and adolescence. Clinical analysis of 10 cases. J Endocrinol Investig 24(2):92–97Google Scholar
  46. 46.
    Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine Society (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(2):273–288Google Scholar
  47. 47.
    Weiss MH (1981) Medical and surgical management of functional pituitary tumors. Clin Neurosurg 28:374–383Google Scholar
  48. 48.
    Liu JK, Couldwell WT (2004) Contemporary management of prolactinomas. Neurosurg Focus 16(4):E2Google Scholar
  49. 49.
    Rosegay H (1981) Cushing’s legacy to transsphenoidal surgery. J Neurosurg 54(4):448–454Google Scholar
  50. 50.
    Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19(1):E3Google Scholar
  51. 51.
    Fujioka M, Young LW (1978) The sphenoidal sinuses: radiographic patterns of normal development and abnormal findings in infants and children. Radiology. 129(1):133–136Google Scholar
  52. 52.
    Jang YJ, Kim SC (2000) Pneumatization of the sphenoid sinus in children evaluated by magnetic resonance imaging. Am J Rhinol 14(3):181–185Google Scholar
  53. 53.
    Szolar D, Preidler K, Ranner G, Braun H, Kern R, Wolf G, Stammberger H, Ebner F (1994) Magnetic resonance assessment of age-related development of the sphenoid sinus. Br J Radiol 67(797):431–435Google Scholar
  54. 54.
    Oliveira RS, Castro M, Antonini SR, Martinelli CE Jr, Moreira AC, Machado HR (2010) Surgical management of pediatric Cushing’s disease: an analysis of 15 consecutive cases at a specialized neurosurgical center. Arq Bras Endocrinol Metabol 54(1):17–23Google Scholar
  55. 55.
    Locatelli D, Massimi L, Rigante M, Custodi V, Paludetti G, Castelnuovo P, di Rocco C (2010) Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 74(11):1298–1302Google Scholar
  56. 56.
    Buchfelder M, Kreutzer J (2008) Transcranial surgery for pituitary adenomas. Pituitary. 11(4):375–384Google Scholar
  57. 57.
    Dolenc VV (1997) Transcranial epidural approach to pituitary tumors extending beyond the sella. Neurosurgery. 41(3):542–550 discussion 551-542Google Scholar
  58. 58.
    Couldwell WT (2004) Transsphenoidal and transcranial surgery for pituitary adenomas. J Neuro-Oncol 69(1–3):237–256Google Scholar
  59. 59.
    Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB (1982) The supraorbital approach: technical note. Neurosurgery. 11(4):537–542Google Scholar
  60. 60.
    Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB (2009) What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base. The Keio journal of medicine 58(3):152–160Google Scholar
  61. 61.
    Berker M, Hazer DB, Yucel T et al (2012) Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary. 15(3):288–300Google Scholar
  62. 62.
    Bokhari AR, Davies MA, Diamond T (2013) Endoscopic transsphenoidal pituitary surgery: a single surgeon experience and the learning curve. Br J Neurosurg 27(1):44–49Google Scholar
  63. 63.
    Cappabianca P, Alfieri A, de Divitiis E (1998) Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg: MIN 41(2):66–73Google Scholar
  64. 64.
    Charalampaki P, Ayyad A, Kockro RA, Perneczky A (2009) Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci: official journal of the Neurosurgical Society of Australasia 16(6):786–789Google Scholar
  65. 65.
    Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, Zanation A, Duz B, Stefko ST, Byers K, Horowitz MB (2011) Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg 114(6):1544–1568Google Scholar
  66. 66.
    Prevedello DM, Doglietto F, Jane JA Jr, Jagannathan J, Han J, Laws ER Jr (2007) History of endoscopic skull base surgery: its evolution and current reality. J Neurosurg 107(1):206–213Google Scholar
  67. 67.
    Massimi L, Rigante M, D’Angelo L et al (2011) Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgery. Acta Neurochir 153(4):843–849Google Scholar
  68. 68.
    Chivukula S, Koutourousiou M, Snyderman CH, Fernandez-Miranda JC, Gardner PA, Tyler-Kabara EC (2013) Endoscopic endonasal skull base surgery in the pediatric population. J Neurosurg Pediatr 11(3):227–241Google Scholar
  69. 69.
    Zhan R, Xu G, Wiebe TM, Li X (2015) Surgical outcomes of the endoscopic transsphenoidal route to pituitary tumours in paediatric patients >10 years of age: 5 years of experience at a single institute. Arch Dis Child 100(8):774–778Google Scholar
  70. 70.
    Guaraldi F, Storr HL, Ghizzoni L, Ghigo E, Savage MO (2014) Paediatric pituitary adenomas: a decade of change. Hormone research in paediatrics 81(3):145–155Google Scholar
  71. 71.
    AlQahtani A, Turri-Zanoni M, Dallan I, Battaglia P, Castelnuovo P (2012) Endoscopic endonasal resection of sinonasal and skull base malignancies in children: feasibility and outcomes. Childs Nerv Syst: ChNS : official journal of the International Society for Pediatric Neurosurgery 28(11):1905–1910Google Scholar
  72. 72.
    Shah RN, Surowitz JB, Patel MR, Huang BY, Snyderman CH, Carrau RL, Kassam AB, Germanwala AV, Zanation AM (2009) Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 119(6):1067–1075Google Scholar
  73. 73.
    Shah MV, Haines SJ (1992) Pediatric skull, skull base, and meningeal tumors. Neurosurg Clin N Am 3(4):893–924Google Scholar
  74. 74.
    Ghosh A, Hatten K, Learned KO, Rizzi MD, Lee JY, Storm PB, Palmer JN, Adappa ND (2015) Pediatric nasoseptal flap reconstruction for suprasellar approaches. Laryngoscope 125(11):2451–2456Google Scholar
  75. 75.
    Rastatter JC, Snyderman CH, Gardner PA, Alden TD, Tyler-Kabara E (2015) Endoscopic endonasal surgery for sinonasal and skull base lesions in the pediatric population. Otolaryngol Clin N Am 48(1):79–99Google Scholar
  76. 76.
    Dehdashti AR, Ganna A, Karabatsou K, Gentili F (2008) Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery. 62(5):1006–1015 discussion 1015-1007Google Scholar
  77. 77.
    O’Malley BW Jr, Grady MS, Gabel BC et al (2008) Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve. Neurosurg Focus 25(6):E10Google Scholar
  78. 78.
    Brown SM, Anand VK, Tabaee A, Schwartz TH (2007) Role of perioperative antibiotics in endoscopic skull base surgery. Laryngoscope 117(9):1528–1532Google Scholar
  79. 79.
    de Almeida JR, Snyderman CH, Gardner PA, Carrau RL, Vescan AD (2011) Nasal morbidity following endoscopic skull base surgery: a prospective cohort study. Head Neck 33(4):547–551Google Scholar
  80. 80.
    Tien DA, Stokken JK, Recinos PF, Woodard TD, Sindwani R (2016) Cerebrospinal fluid diversion in endoscopic skull base reconstruction: an evidence-based approach to the use of lumbar drains. Otolaryngol Clin N Am 49(1):119–129Google Scholar
  81. 81.
    Zwagerman NT, Wang EW, Shin SS, Chang YF, Fernandez-Miranda JC, Snyderman CH, Gardner PA (2018) Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg 1:1–7Google Scholar
  82. 82.
    Tien DA, Stokken JK, Recinos PF, Woodard TD, Sindwani R (2016) Comprehensive postoperative management after endoscopic skull base surgery. Otolaryngol Clin N Am 49(1):253–263Google Scholar
  83. 83.
    Benveniste RJ, King WA, Walsh J, Lee JS, Delman BN, Post KD (2005) Repeated transsphenoidal surgery to treat recurrent or residual pituitary adenoma. J Neurosurg 102(6):1004–1012Google Scholar
  84. 84.
    Ram Z, Nieman LK, Cutler GB Jr, Chrousos GP, Doppman JL, Oldfield EH (1994) Early repeat surgery for persistent Cushing’s disease. J Neurosurg 80(1):37–45Google Scholar
  85. 85.
    Storr HL, Plowman PN, Carroll PV, François I, Krassas GE, Afshar F, Besser GM, Grossman AB, Savage MO (2003) Clinical and endocrine responses to pituitary radiotherapy in pediatric Cushing’s disease: an effective second-line treatment. J Clin Endocrinol Metab 88(1):34–37Google Scholar
  86. 86.
    Kanter AS, Diallo AO, Jane JA Jr et al (2005) Single-center experience with pediatric Cushing’s disease. J Neurosurg 103(5 Suppl):413–420Google Scholar
  87. 87.
    Follin C, Erfurth EM (2016) Long-term effect of cranial radiotherapy on pituitary-hypothalamus area in childhood acute lymphoblastic leukemia survivors. Curr Treat Options in Oncol 17(9):50Google Scholar
  88. 88.
    Sklar CA, Constine LS (1995) Chronic neuroendocrinological sequelae of radiation therapy. Int J Radiat Oncol Biol Phys 31(5):1113–1121Google Scholar
  89. 89.
    Constine LS, Woolf PD, Cann D, Mick G, McCormick K, Raubertas RF, Rubin P (1993) Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 328(2):87–94Google Scholar
  90. 90.
    Di Ieva A, Rotondo F, Syro LV, Cusimano MD, Kovacs K (2014) Aggressive pituitary adenomas--diagnosis and emerging treatments. Nat Rev Endocrinol 10(7):423–435Google Scholar
  91. 91.
    Storr HL, Savage MO (2015) Management of endocrine disease: paediatric Cushing’s disease. Eur J Endocrinol 173(1):R35–R45Google Scholar
  92. 92.
    Baskin DS, Boggan JE, Wilson CB (1982) Transsphenoidal microsurgical removal of growth hormone-secreting pituitary adenomas. A review of 137 cases. J Neurosurg 56(5):634–641Google Scholar
  93. 93.
    Sudhakar N, Ray A, Vafidis JA (2004) Complications after trans-sphenoidal surgery: our experience and a review of the literature. Br J Neurosurg 18(5):507–512Google Scholar
  94. 94.
    Katznelson L, Klibanski A (1997) Prolactinomas. Cancer Treat Res 89:41–55Google Scholar
  95. 95.
    Hoorn EJ, Zietse R (2010) Water balance disorders after neurosurgery: the triphasic response revisited. NDT plus 3(1):42–44Google Scholar
  96. 96.
    Crock PA, Ludecke DK, Knappe UJ, Saeger W (2018) A personal series of 100 children operated for Cushing’s disease (CD): optimizing minimally invasive diagnosis and transnasal surgery to achieve nearly 100% remission including reoperations. J Pediatr Endocrinol Metab: JPEM 31(9):1023–1031Google Scholar
  97. 97.
    Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97(2):293–298Google Scholar
  98. 98.
    Perry A, Graffeo CS, Copeland WR 3rd et al (2017) Delayed cerebrospinal fluid rhinorrhea after gamma knife radiosurgery with or without preceding transsphenoidal resection for pituitary pathology. World neurosurgery 100:201–207Google Scholar
  99. 99.
    Garcia-Navarro V, Anand VK, Schwartz TH (2013) Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World neurosurgery 80(5):563–568Google Scholar
  100. 100.
    Kassam AB, Thomas A, Carrau RL et al (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63(1 Suppl 1):ONS44–ONS52 discussion ONS52-43Google Scholar
  101. 101.
    Zhang Y, Tian Z, Li C et al (2019) A modified endovascular treatment protocol for iatrogenic internal carotid artery injuries following endoscopic endonasal surgery. J Neurosurg 25:1–8Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Patrick C. Walz
    • 1
    • 2
    Email author
  • Annie Drapeau
    • 3
    • 4
  • Ammar Shaikhouni
    • 3
    • 4
  • Jacob Eide
    • 5
  • Alex J. Rugino
    • 6
  • Ahmed Mohyeldin
    • 3
  • Ricardo Carrau
    • 1
    • 2
    • 3
  • Daniel Prevedello
    • 3
    • 4
  1. 1.Department of OtolaryngologyThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of Pediatric OtolaryngologyNationwide Children’s HospitalColumbusUSA
  3. 3.Department of NeurosurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  4. 4.Department of Pediatric NeurosurgeryNationwide Children’s HospitalColumbusUSA
  5. 5.Department of OtolaryngologyNorthwestern University Feinberg School of MedicineChicagoUSA
  6. 6.OhioHealth NeurosurgeryColumbusUSA

Personalised recommendations