The pituitary gland sits at the base of the brain, just behind the nose. Endoscopic endonasal surgery, also called transsphenoidal surgery, reaches it through the nostrils instead of opening the skull. A thin lighted camera is passed through the nose into the sinus behind it, and small instruments are used alongside the camera to remove the tumor.
There is no incision on the face or scalp and the brain is not moved aside. It is often a two-surgeon operation, with a neurosurgeon and an ear, nose and throat surgeon working together. The transsphenoidal route is used for roughly 95% of pituitary tumor operations.
Most of these tumors are pituitary adenomas. The same approach is also used for Rathke cleft cysts, craniopharyngiomas and some tumors of the skull base.
Symptoms that lead to surgery include loss of side vision, headaches, fatigue, missed periods or infertility, sexual problems, and milky nipple discharge. Tumors that overproduce a hormone can cause acromegaly or Cushing’s disease. Vision is affected in roughly 40% to 60% of larger tumors. Not every pituitary tumor needs surgery: prolactin-producing tumors often respond to medication, and small tumors that cause no symptoms may simply be watched with scans.
The operation is done under general anesthesia and usually takes two to four hours. Most patients are in hospital one to three days, and many stay a single night. Most people are back to their usual activities in about six weeks. Early on you will be asked not to lift more than 10 pounds, not to blow your nose, to avoid strenuous exercise, and to keep to a daily fluid limit while hormone levels settle. Follow-up includes an MRI, hormone blood tests and formal vision testing.
A leak of spinal fluid through the nose is the most common complication. Other risks include low pituitary hormone levels needing hormone replacement, a temporary or lasting problem with water balance (arginine vasopressin deficiency, once called diabetes insipidus), and, less often, bleeding, infection or vision problems. Roughly 18% of non-hormone-producing adenomas and about 25% of prolactinomas come back over time, which is why long-term imaging and hormone follow-up matter.
Will I have a scar or a shaved head? No. The surgery goes through the nostrils.
Will I need hormone pills afterward? Some patients do, and blood tests after surgery will show whether you are one of them.
How long will my nose feel blocked? Congestion and crusting are expected for a few weeks while the nose heals.
Sources: Mayo Clinic; Johns Hopkins Medicine; Cleveland Clinic; American Association of Neurological Surgeons.
To have a pituitary tumor evaluated in Lake Worth or Jupiter, call (561) 433-4444.
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