Delayed puberty surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

The mainstay of treatment for delayed puberty is medical therapy. Surgery is usually reserved for patients with either pituitary tumors, hypothalamus hamartomas, and Turner syndrome. There are two procedures for excision of pituitary tumors, including endoscopic transsphenoidal surgery and craniotomy. In Turner syndrome with Y chromosome, the chance of becoming malignant is higher . Thus, oophorectomy (even salpingo-oophorectomy) has to be done urgently.

The mainstay of treatment for delayed puberty is medical therapy. Surgery is usually reserved for patients with either:

• Pituitary tumors
• Hypothalamus hamartomas
• Turner syndrome

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• In this method, the pituitary tumor is excised through nostrils by means of a tiny fiber-optic endoscopic tube.
• First bilateral nasal septal mucosa is incised in a C-shaped manner. The septal bone is approached through the incisions.
• Then, the sphenoidal rostrum and anterior wall of sphenoid sinus are gradually removed, a bone window is opened through the skull.
• After that, the dura mater is passed and the lesion becomes visualized.
• Finally, the tumor is removed using the curette and basket with suction.
• Advantages
  • No harm to other parts of the brain
  • High cure rate
  • No visible scar
• Disadvantages
  • Not for large tumors
  • Recurrent sinusitis in the future
  • Low cure rate in case of suprasellar adhesion to adjunct tissues

• Although the preferred procedure to excise the pituitary tumors is a transsphenoidal approach, in some cases (1-4%) the size of the tumor or any suprasellar adhesion is indicative of a transcranial method.
• Some indications for transcranial method include:
  • Isolation by a narrow waist at the diaphragma sellae
  • Containment within the cavernous sinus lateral to the carotid artery
  • Projection anteriorly onto the planum sphenoidal
  • Projection laterally into the middle fossa
• Skull base surgical procedure is also an option for pituitary tumor treatment but may encounter the same problems that transsphenoidal method is faced with.
• Advantages
  • Resection of large tumors
  • Ability to excise the tumors with suprasellar specific conditions
• Disadvantage
  • Long duration of post-operation recovery
  • Harm to other parts of the brain

• Since the dysgenetic ovaries in Turner syndrome have a higher risk of malignancy, they have to be resected whenever the disease is diagnosed.
• In condition that patient with Turner syndrome has Y chromosome, the chance of becoming malignant is higher. Thus, oophorectomy (even salpingo-oophorectomy) has to be done urgently.^[4]

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