Endoscopic endonasal pituitary tumor resection is a minimally invasive surgical method for removing tumors from the pituitary gland. This technique accesses the gland by passing instruments through the nostrils, avoiding external incisions on the face or skull. Surgeons perform this procedure to alleviate pressure on surrounding structures like the optic nerves, which can cause vision problems. It also addresses hormonal imbalances caused by tumors that produce excess hormones.
The Endonasal Surgical Pathway
The endonasal approach utilizes the body’s natural anatomy. The nasal passages and the sphenoid sinus—a hollow cavity behind the nose—form a natural corridor to the pituitary gland. This pathway allows surgeons to reach the sella turcica, the pocket of bone cradling the gland, without external cuts or disturbing the brain.
This procedure is a collaborative effort between two surgical specialists. An Otolaryngologist (ENT surgeon) begins the operation by navigating the nasal and sinus cavities to create a clear path. Once access is established, a Neurosurgeon takes over to perform the tumor removal from the pituitary gland.
The Surgical Procedure Step-by-Step
The procedure begins with the patient under general anesthesia. Surgeons utilize advanced technology, including high-definition endoscopes (thin, lighted tubes with a camera) for a clear view. They also use sophisticated image-guidance systems, which act like a GPS for the anatomy, to navigate precisely.
The ENT surgeon guides the endoscope through a nostril to the back of the nasal cavity. A small opening is made into the sphenoid sinus, followed by another in the sella turcica bone to expose the pituitary tumor. This creates the entryway for the neurosurgeon.
With the pathway cleared, the neurosurgeon begins the tumor resection. Using micro-instruments passed alongside the endoscope, the surgeon separates the tumor from the healthy pituitary gland and surrounding tissues. Softer tumors may be suctioned out, while firmer ones might require more intricate dissection.
The final stage is the closure. The surgical team reconstructs the opening to the sella turcica using the patient’s own tissue, such as fat from the abdomen or tissue from the nasal septum. This material is combined with biological glue to create a durable, watertight seal, which prevents cerebrospinal fluid (CSF) from leaking.
Post-Operative Recovery and Care
Following surgery, the patient recovers in a specialized setting like an intensive care unit for close observation. Initial experiences include nasal congestion from dissolvable packing, headaches, and fatigue. Medical staff monitor hormone levels and urine output to detect conditions like diabetes insipidus, which affects the body’s water balance.
Upon returning home, patients receive instructions to facilitate healing. For several weeks, activities must be avoided to protect the surgical repair, including:
- Blowing the nose
- Sneezing with a closed mouth
- Using straws
- Heavy lifting or straining
Regular follow-up appointments with the surgical team and an endocrinologist are scheduled to monitor healing and hormone function. Most patients return to work and normal activities within four to six weeks.
Surgical Risks and Expected Outcomes
While the procedure is safe, it carries potential risks. The most significant complication is a cerebrospinal fluid (CSF) leak, where fluid escapes the surgical site, elevating the risk of meningitis. Other risks include bleeding, damage to the healthy pituitary gland requiring hormone replacement therapy, and, in rare cases, injury to nearby blood vessels or optic nerves.
The procedure has a high success rate, particularly for smaller tumors. Patients with vision problems from optic nerve compression often see rapid improvement. For hormone-secreting tumors, surgery effectively corrects overproduction, with success rates around 70-85% depending on the tumor type. This technique results in a shorter hospital stay, less pain, and a quicker return to normal activities compared to open-skull surgery.