The pituitary gland is a pea-sized structure located at the base of the brain. It functions by producing hormones that control or regulate various functions of the body such as growth, metabolism, sexual development and reproduction.

Pituitary adenomas are noncancerous tumors that form in the pituitary gland. These tumors cause hormonal imbalance in the body by either secreting excessive levels of a particular hormone or more than one type of hormone. They can also grow in size and compress important arteries and nerves at the base of the skull. Endoscopic trans nasal transphenoidal surgery is a minimally invasive procedure where the pituitary tumor is removed by working through the nose. This surgical technique can also be used to remove tumors located in other regions of the skull base.

Trans nasal transphenoidal surgery is a minimally invasive technique performed to remove pituitary adenomas by inserting an endoscope through the nose. An endoscope is a long tube with a camera attached at the end that sends images to a computer screen for the surgeon to view inside the body.

Indications

Endoscopic trans nasal transphenoidal surgery can be utilized to remove pituitary tumors which are compressing critical brain structures or are over secreting certain hormones.

Surgical procedure

The surgery is performed general anesthesia.

You will lie on your back on the operating table and your nasal cavity will be prepared with antibiotic and antiseptic solution.

An image-guided device is placed on your head which creates a 3D map on a computer screen. This map assists your surgeon in navigating through the nose.

A thin endoscopic tube attached to a lighted device and a video camera at its end is inserted through one nostril and moved up to the back of the nasal cavity. A small portion of the nasal septum separating the two nostrils and the wall of the sphenoid sinus is opened.

The surgeon then makes an opening in a thin bone overlying the pituitary gland called the sella, to view the dura (the covering of the brain). The dura is then opened to view the tumor and pituitary gland.

Your surgeon uses special instruments called curettes through the other nostril to remove the tumor.

At the conclusion of the procedure your surgeon will usually take a fat graft from your abdomen which is used to repair the opening into the skull base and to prevent any CSF fluid leakage. Sometimes bone graft may be used to close the opening made in the skull base.

Your surgeon will apply biologic glue over the graft to promote healing and prevent leakage of cerebrospinal fluid into the nasal cavity.

Post-Operative Care

After the surgery, medications are prescribed to control nausea, pain and nasal congestion. Your doctor will check to see if the pituitary gland is functioning normally. Hormonal medications may be prescribed if the pituitary gland fails to produce the required level of hormones.

Avoid coughing, sneezing, blowing your nose, and straining during bowel movements for a few weeks after surgery. Resume normal activities gradually. If a fat graft has been obtained from the abdomen, keep the wound open to air and prevent contact with water. Consult your doctor immediately if you experience continuous nasal drainage, excessive swallowing, nasal bleeding, high fever, frequent urination or weight loss.

Recovery

Crusts can form in your nose, causing nasal congestion. These can be removed safely by spraying local anesthetic in the nasal cavity. Nasal saline rinses may be recommended to remove the crusts and promote healing of the wounds.

Risks and complications

As with any surgery, endoscopic trans nasal transphenoidal resection of pituitary adenoma can be associated with certain risks and complications, which include:

  • Loss of vision due to damaged optic nerves
  • Pituitary gland damage
  • Diabetes insipidus
  • Nasal deformity and bleeding
  • Stroke
  • Cerebrospinal fluid leak and meningitis (tissue layers covering the brain)

Benefits

The resection of the pituitary adenoma through endoscopic trans nasal transphenoidal surgery has several benefits over open surgery, which include

  • No external incisions and no visible scars
  • Minimal loss of blood
  • Removes large tumors
  • Faster healing and recovery time.
  • Shorter hospital stay
  • American Association of Neurological Surgeons
  • American Board of Neurological Surgery
  • American Medical Association
  • The Congress of Neurological Surgeons
  • College of Physicians and Surgeons of Newfoundland & Labrador
  • North American Skull Base Society
  • North American Spine Society