Risks of Endoscopic Endonasal Transsphenoidal Surgery

Transsphenoidal surgery is a minimally invasive procedure used to treat tumors and other mass lesions of the pituitary gland. Unlike traditional brain surgery, this approach accesses the tumor through the nasal passages, avoiding the need for a craniotomy.

If you or a loved one has been diagnosed with a pituitary tumor, your surgeon may recommend this procedure as the first line of treatment, especially if the tumor is relatively small and easily accessed with this innovative procedure

This procedure is known for its precision. Surgeons use an endoscope or microscope to ensure that every step is performed under excellent visualization.

The entire surgery typically takes 2 to 4 hours, depending on the complexity of the tumor. The recovery is usually smooth, with minimal disruption to daily life. 

After surgery, it is normal to experience nasal congestion and headaches. These symptoms usually resolve on their own, but medications can help manage discomfort.

Recovery is generally uneventful, though some pain and discomfort are expected. Despite being minimally invasive, the procedure does involve tissue manipulation.

Be sure to discuss the potential risks and complications with your medical team to fully understand the surgery and its associated recovery process. 

Following transsphenoidal surgery, the most common issue to arise is postoperative hypopituitarism (or abnormally low pituitary function), which affects roughly 19% of patients. Diabetes insipidus (a manifestation of hypopituitarism) is particularly notable, affecting almost 17% of individuals.

Diabetes insipidus occurs when there is not enough antidiuretic hormone, resulting from damage to the posterior portion of the pituitary gland.

Symptoms indicative of diabetes insipidus include frequent urination and excessive thirst. Patients may notice abnormally clear, colorless urine excessive in both frequency and volume, associated with this condition. 

This highlights the need for careful monitoring and treatment after surgery. During this time, your fluid intake and output volumes will be measured along with your electrolyte levels to ensure they are stable prior to discharge.

Electrolyte levels will return to normal as the pituitary gland regains function and resumes regulating the body’s normal homeostatic fluid and electrolyte balance.

Other possible complications following transsphenoidal surgery include:

• Bleeding and Stroke: Bleeding is expected during surgery and will be managed by the surgical team as they perform the operation. Stroke is a rare potential complication that may occur in cases of extensive bleeding.
• Cerebrospinal Fluid (CSF) Leakage: Although rare, this can be serious, causing signs and symptoms such as headache and drainage of clear fluid from the nose (rhinorrhea). CSF leakage is indicative of a breach in the dura, the outer protective layer surrounding the brain. It is associated with an increased risk of infection. CSF leaks are managed with bed rest, head elevation, avoidance of activities (such as straining or heavy lifting) that increase intracranial pressure, and sometimes surgical repair.
• Sinus Problems: Temporary issues like congestion, discharge, or crusting. Postoperative post-nasal drip usually improves as healing progresses. Bone removal during surgery might lead to nasal deformities.
• Headaches: Postoperative headaches are manageable with medications for most patients.
• Hormonal Imbalances: Surgery may affect hormone levels, requiring monitoring and, in some cases, hormone replacement therapy.
• Infection: While uncommon, infection at the surgical site is possible.
• Depression: Some patients may experience mood changes, including depression, during recovery. Empathy and emotional support will be helpful during this time.
• Personality Changes: Hormonal fluctuations post-surgery may lead to personality changes in some individuals.
• Altered Smell: As the nasal passages heal, temporary changes in smell may occur, including a loss of smell for several weeks.
• Vision Problems: Damage to the optic nerves can cause vision loss or worsening vision.
• Delayed Complications: Some patients may experience slow healing of the surgical incision, leading to discomfort or recurrent symptoms. Scar tissue development is also possible.

Transsphenoidal surgery is considered safe when performed by experienced neurosurgeons or ear, nose, and throat specialists skilled in this procedure. It is a well-established and effective method for treating pituitary tumors.

However, like any surgery, it carries potential risks and complications, as mentioned earlier.

The likelihood of complications varies based on the tumor's size and invasiveness.

Surgical treatment for hormone-secreting pituitary adenomas has a success rate of about 70%. Moreover, vision problems related to the tumor can improve or normalize in up to 92% of patients.

It is crucial to note that individuals diagnosed with a pituitary tumor have an exceptionally favorable prognosis, with an impressive 97% 5-year survival rate.

• Transsphenoidal surgery is a procedure that involves entering the skull base through the nasal passage to expose and then reach the pituitary tumor, which can often be removed within the span of 2-4 hours (the typical length of time for the entire procedure).
• Individuals diagnosed with a pituitary tumor have an exceptionally favorable prognosis with a 5-year survival rate of 97%. Any complications resulting from surgical intervention are usually minor and self-limiting, meaning they will resolve on their own.
• Complications of transsphenoidal surgery may include fluid or hormonal imbalances, infection, cerebrospinal fluid leakage, vision problems, bleeding, headaches, and sinus issues.
• Personality changes can occur after transsphenoidal surgery, impacting an individual's emotional and behavioral well-being.

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