Benefits of Endoscopic Endonasal Transsphenoidal Surgery

Transsphenoidal surgery is a procedure designed to access the base of the skull by means of the nasal passage. This technique is frequently employed for the extraction of tumors situated in proximity to the pituitary gland, a small bean-shaped organ behind the eyes in the base of the skull, crucial for hormone regulation.

Pituitary tumors can put pressure against the optic nerves, causing visual disturbances or even vision loss. This can affect a person's ability to perform daily tasks, drive, or engage in activities they once enjoyed.

Transsphenoidal surgery involves the insertion of instruments through the nasal passage, followed by the careful removal of the sphenoid bone beneath the brain, at the level of the skull base, to reach the tumor.

This less invasive method results in no visible scarring and facilitates a speedier recovery process.

Transsphenoidal surgery is commonly used for tumors such as pituitary adenomas, selected meningiomas, craniopharyngiomas, and increasingly, considered to tackle more types of complex brain tumors.

In this article, we will discuss the benefits of transsphenoidal surgery and answer common questions you may have.  

Transsphenoidal surgery offers a minimally invasive approach for the effective removal of tumors. The success rate of transsphenoidal surgery can vary depending on several factors, including the type of tumor, its size, its invasiveness, the skill and experience of the surgical team, and the individual patient’s overall health.

Generally, transsphenoidal surgery is considered a highly effective treatment option for many pituitary tumors and skull base lesions.

In cases of hormone-secreting pituitary adenomas, the reported rate of surgical treatment success, in terms of achieving hormone normalization, stands at approximately 70%. Remarkably, as many as 92% of patients experience an improvement of vision issues resulting from the tumor following the procedure.

Patients considering transsphenoidal surgery should have a detailed discussion with their medical team to understand their case and the potential risks and benefits of the procedure. It is important to note that the prognosis for individuals with a pituitary tumor is highly favorable, with an outstanding 5-year survival rate of 97%.

• Minimally Invasive: Transsphenoidal surgery is minimally invasive compared to traditional open cranial surgeries. It avoids the need for large incisions or removal of significant portions of the skull, resulting in less tissue disruption and trauma.
• Lower Risk of Complications: Because transsphenoidal surgery avoids extensive skull manipulation, it often carries a lower risk of complications such as infection, cerebrospinal fluid leakage, and damage to surrounding structures.
• Hormonal and Vision Improvement: In cases of pituitary adenomas, this surgery often leads to the improvement or normalization of hormone levels and vision problems related to the tumor.
• Preservation of Healthy Tissue: Transsphenoidal surgery enables surgeons to access the pituitary gland and nearby structures precisely, minimizing damage to healthy tissue and structures.
• Improved Cosmetic Outcome: The surgery leaves no visible external scars since it is performed through the nasal passages, preserving the patient's appearance.

The duration of transsphenoidal surgery can vary depending on several factors, including the complexity of the procedure, the surgeon's experience, and the specific condition being treated.

On average, a transsphenoidal surgery for pituitary tumor removal typically takes approximately 2 to 4 hours. However, it's important to note that this is a general estimate and individual cases may differ.

Following transsphenoidal surgery, you will undergo post-operative monitoring in either the intensive care unit (ICU) or a standard hospital ward. Immediately after the procedure, you may experience nasal congestion, making normal breathing a bit challenging.

Breathing through your mouth might be more comfortable during this time. Additionally, you may encounter blood-tinged nasal drainage, occasional nausea, or headaches, which typically resolve naturally or are addressed with prescribed medications.

While blood-tinged drainage is normal, inform a member of your care team if you notice consistently clear, or consistently bloody, persistent nasal drainage.

These findings may represent a cerebrospinal fluid leak, or surgical bleeding, and should be urgently addressed. 

Furthermore, the typical hospital stay is usually limited to 1 to 2 days. Upon returning home, it's crucial to adhere to the post-operative instructions provided by your surgeon.

You may also be scheduled for a follow-up appointment with your neurosurgeon within 1 to 2 weeks after the surgery to monitor your progress and address any concerns.

• Transsphenoidal surgery is a technique aimed at reaching the base of the skull through the nasal passages.
• There is a reported surgical success rate of around 70%.
• It is often associated with a reduced risk of complications, compared to a traditional craniotomy approach.
• Persistent totally clear or totally bloody drainage should be urgently addressed with your care team. 
• The procedure typically takes approximately 2 to 4 hours.

• Endocrine Society
• Pituitary Foundation
• National Adrenal Diseases Foundation
• American Association of Neurological Surgeons (AANS)