Pituitary Transsphenoidal Surgery
Pituitary transsphenoidal surgery is a specialized, minimally invasive surgical procedure performed to remove pituitary tumours. Accessing the skull base directly through the nostrils (trans-nasal approach) using high-definition endoscopes, the surgeon can remove the tumour without making any external facial incisions or opening the skull, immediately relieving pressure on the optic nerves.
When this procedure may be recommended
- Pituitary adenomas causing hormone imbalances (acromegaly, Cushing disease, prolactinomas refractory to medication).
- Non-functioning pituitary adenomas compressing the optic chiasm and causing vision loss (hemianopia).
- Other skull base lesions like Rathke cleft cysts or craniopharyngiomas.
Who may be a candidate
Recommended for patients with pituitary masses causing hormonal dysfunction or visual deficits. Extremely large tumours with extensive lateral extension into the cavernous sinuses or brain tissue may require a combined approach or supplementary radiosurgery.
Advanced medical implant technology (no text). Alternatives to surgery
- Medical management (dopamine agonists for prolactinomas).
- Stereotactic radiosurgery (focused radiation to arrest tumour growth).
- Observation with regular endocrine and visual field testing for small, asymptomatic tumours.
What to expect
- Access: Under general anaesthesia, a high-definition endoscope is passed through the nostril and nasal cavity.
- Sphenoid Opening: The sphenoid sinus (a hollow space at the back of the nose) is opened, providing direct access to the sella turcica (the bony cradle of the pituitary gland).
- Tumour Exposure: The thin bone of the sella is opened, and the protective dura is incised to expose the tumour.
- Resection: The tumour is carefully debulked and removed using specialized angled instruments, protecting the normal pituitary gland.
- Reconstruction: The skull base is reconstructed using fat, fascia, or synthetic grafts to prevent cerebrospinal fluid leakage.
- Closure: Nasal passages are checked, and soft nasal packing may be placed (no external cuts).
Technology and imaging
Uses high-definition 3D endoscopes, intraoperative image-guided neuronavigation, and Doppler ultrasound to track local carotid arteries.
High-precision diagnostic imaging visualization. 
Clinical Zeiss/Leica operating microscope setup. Hospital stay
Typically 2 to 3 nights, allowing careful monitoring of fluid balance and hormone levels.
Recovery milestones
- Day 1: Mobilisation. Urine output and fluid intake are meticulously monitored to check for diabetes insipidus.
- Weeks 1-4: Home rest. Strict instructions: NO nose-blowing, sneezing with mouth open, or drinking through straws to protect the skull base seal.
- Endocrine Review: Hormone levels are checked at 4-6 weeks to coordinate hormone replacement if needed.
Post-operative mobilization and recovery milestones. Risks and complications
- Cerebrospinal fluid (CSF) leak through the nose (2% to 4% risk, requiring surgical repair or a spinal drain).
- Temporary or permanent hormonal imbalance (diabetes insipidus, hypothyroidism, adrenal insufficiency).
- Meningitis (due to nasal bacteria entering the skull base).
- Visual deficit or carotid artery injury (extremely rare).
Frequently asked questions
Will I have facial scars after pituitary surgery?
No. The entire procedure is performed internally through the nostrils, meaning there are absolutely no external facial cuts, scars, or changes to the shape of your nose.