Nose Treatments

Endoscopic Skull Base and Pituitary Surgery

Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope camera and light to remove tumors with long instruments. Pituitary tumors can cause hormone problems and vision loss. Tumor removal often reverses vision problems and restores normal hormone balance.

What is transsphenoidal pituitary surgery?

Transsphenoidal literally means “through the sphenoid sinus.” It is a surgery performed through the nose and sphenoid sinus to remove pituitary tumors. Transsphenoidal surgery can be performed with an endoscope, microscope, or both. It is often a team effort between neurosurgeons and ear, nose, and throat (ENT) surgeons.

A traditional microscope technique uses a skin incision under the upper lip and removal of a large portion of the nasal septum so that the surgeon can directly see the sphenoid sinus area.

A minimally invasive technique, called endoscopic endonasal surgery, uses a small incision at the back of the nasal cavity and causes little disruption of the nasal tissues. The ENT surgeon works through the nostrils with a tiny camera and light called an endoscope. In both techniques, bony openings are made in the nasal septum, sphenoid sinus, and sella to reach the pituitary. Once the pituitary is exposed, the neurosurgeon removes the tumor.

Who is a candidate?

You may be a candidate for transsphenoidal surgery if you have a:

• Pituitary adenoma:-a tumor that grows from the pituitary gland; may be hormone-secreting or not.
• Craniopharyngioma:- a benign tumor that grows from cells near the pituitary stalk; may invade the third ventricle.
• Rathke’s cleft cyst:-a benign cyst, or fluid-filled sac, between the anterior and posterior lobes of the pituitary gland.
• Meningioma:-a tumor that grows from the meninges (dura), the membrane that surrounds the brain and spinal cord.
• Chordoma:-a malignant bone tumor that grows from the skull base.

If you have a prolactinoma or a small (<10mm) non-secretory tumor, surgery may not be required. These types of tumors respond well to medication or may be observed with periodic MRIs to watch for tumor growth.