Transnasal and Endonasal Transsphenoidal Surgery
Transnasal transsphenoidal (TNTS) surgery is currently the preferred method of removing a pituitary adenoma (tumor) or cyst. It is also used for certain suprasellar tumors (above the pituitary gland), retro-sellar (behind the gland) and infra-sellar (below the gland) tumors, craniopharyngiomas, meningiomas, chordomas and epidermoid masses.
Using this approach, the surgeon enters through the sphenoid sinus, an air space behind the nose, to remove a mass. As a result, there is no external incision or scar. This approach is less invasive than a craniotomy because it is the most direct route to the pituitary gland. The operative time is typically shorter and patients recover more rapidly.
Endonasal (through a nostril) transsphenoidal surgery is a more minimally-invasive approach for removal of pituitary adenomas, Rathke’s cleft cysts, craniopharyngiomas and midline suprasellar meningiomas. With this approach, there is no incision under the lip and minimal nasal mucosal dissection, as the surgeon makes an incision in the back wall of the nose and the sphenoid sinus is entered directly. Because there is less dissection, a shorter and more comfortable post-operative recovery is typical.
Both transnasal transphenoidal and endonasal techniques employ microscopic or endoscopic assistance and surgical navigation techniques to assist with tumor removal and reduce the risk of injury to adjacent structures within the brain.
The decision regarding which procedure is most appropriate is based on the specific type, size and location of the tumor, and is typically made after review of a brain MRI scan.