Transsphenoidal surgery is performed to treat tumors of the pituitary gland. Because the pituitary gland produces hormones affecting many systems of the body, patients with pituitary tumors may suffer from a great variety of symptoms include headaches, vision loss and seizures.
Although pituitary tumors are usually benign, successful treatment of their disturbing symptoms almost always requires surgical removal of the tumor, often accompanied by medication and radiation therapy. Such surgery may be performed through the skull (craniotomy) or as transsphenoidal surgery, crossing through the sphenoid sinus at the back of the nose.
Types of Transsphenoidal Surgery
Transsphenoidal surgery may be performed either as an open procedure or endoscopically, depending on the size and location of the tumor. Both operations are performed under general anesthesia. The endoscopic procedure, using miniature surgical tools, computer magnification, and guided imaging, is usually the preferred method of treatment since it is minimally invasive, accessing the pituitary tumor through the nostrils. Not only does endoscopic surgery require no incisions, it results in shorter recovery time, less scarring and a lower risk of complications.
When endoscopic surgery is not possible because of the size or location of the tumor, open surgery is performed through an incision in the nose or below the lip inside the mouth. The goal of either surgical procedure is to remove the entire tumor by sections, but if the growth is too close to a nerve or major blood vessel this may not be possible. In such cases, partial removal of the tumor, which leaves healthy tissue intact, is considered safer.
The Transsphenoidal Procedure
Either type of transsphenoidal surgery involves the creation of a hole in the bone behind the nose since this allows the surgeon access to the pituitary gland. Once the tumor is sectioned and removed, the region will be carefully examined to make sure there are no remaining hidden portions of diseased tissue. In some cases, a small amount of fatty tissue is transplanted from another part of the patient's body, such as the abdomen, to fill the space left by the tumor's removal. Either a bone graft from the patient's septum, the partition between the nostrils, or a piece of synthetic mesh will be used to support the portion of removed skull bone. This helps to prevent the leakage of cerebrospinal fluid.
Recovery from Transsphenoidal Surgery
After surgery, patients usually remain hospitalized for a day or two. Typically, patients experience uncomfortable symptoms for a few days following surgery including headache, nausea and nasal congestion. These symptoms can be alleviated with medication. During recovery it is important for patients to refrain from nose blowing, sneezing, coughing and drinking through straws.
Risks of Transsphenoidal Surgery
Transsphenoidal surgery for the removal of tumors is considered a safe procedure, but all forms of surgery carry some risk. The complications that are associated with transsphenoidal surgery include bleeding, infection, pituitary gland damage, cerebrospinal fluid leakage, vision loss and, very rarely, stroke. Nonetheless the risks of untreated pituitary tumors are most often greater than the risks of surgery, since such tumors may lead to severe hormonal imbalances, diabetes and permanent blindness.