What is Transsphenoidal surgery?

For many patients diagnosed with a pituitary tumor that is operable and of appropriate size, the safest and simplest treatment is to remove the tumor by approaching it via the boney back wall of the sphenoid sinus. One advantage over the more traditional cranial operation is that it is much safer. No part of the brain is touched during the transsphenoidal procedure, so the risk of brain damage is very low. There may be fewer side effects, and there's also no visible scar.

There are three basic approaches to the cavity in the skull base (known as the sella) where the pituitary gland is located. Many surgeons now use a direct transnasal approach, in which an incision is made in the back wall of the nose and the sphenoid sinus is accessed directly. Another approach is to make an incision along the front of the nasal septum, and open a narrow tunnel back to the sphenoid sinus. Finally, it is possible to make an incision under the lip and through the upper gum, entering the nasal cavity and then the sphenoid sinus.

Another approach - endosopic surgery - is available, depending on the tumor's position and the shape of the sphenoid sinus. The endoscope is a thin fiber-optic tube tipped with a tiny camera. No incision is needed, because the endoscope allows the surgeon to visualize the area through a small incision made in the back of the nasal septum. The instruments are passed through the nose and through the sphenoid sinus to reach the pituitary gland and excise the tumor.

What are the risks?

There's a small risk of damage to the healthy portion of the pituitary, with an occurence rate of 5-10%; this could make it necessary to administer hormone therapy after surgery, possibly including thyroid hormone, cortisol, growth hormone, estrogen or testosterone. If the back of the pituitary gland is damaged (very rare, with an incidence of just 1 - 2%), it could cause a condition called diabetes insipidus, which causes frequent urination and excessive thirst, because the kidneys don't adequately concentrate the urine. This can be controlled with a medicine called DDAVP, administered via nasal spray or pill form of a medication called DDAVP.

Ask your surgeon to review the risks and complications as part of the decision-making process for your individual case.

How long does the procedure take?

The procedure itself takes about three hours in typical cases. Patients spend two to three hours in the recovery room after the surgery, and are then often admitted for a stay of one or two days in general hospital care. Most patients are discharged in one or two days.

How long will it take to recover?

You can expect to have a sinus headache and nasal congestion, relieved by decongestants prescribed by your surgeon, and subsiding over a period of a couple of weeks. You will likely be out of work for up to two weeks, with residual fatigue from the surgery lasting two to three weeks.

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