Transsphenoidal Tumor Resection
Most pituitary tumors are removed by the transsphenoidal method of surgery, which means the surgery is directed through the nose to the bottom of your skull where the pituitary gland is located.. In the past, transsphenoidal surgery was started by making a one to two inch incision under your lip at the top of your upper gum or within the front part of the nose
In recent years, the surgery has been modified so that there is no need for an incision under the lip or in the front part of the nose. The new procedure is called an endonasal procedure because the tumor is approached through the nasal cavity without an incision. There is no incision on the face.
The tumor is reached by working through one nostril and making a hole in the back of the nose into the bottom of the skull. Through this hole, the surgeon can see the bottom of the pituitary gland and the tumor, and can thus remove the tumor. The endonasal procedure reduces operating room time by as much as two hours, reduces the discomfort associated with the surgery, and allows for a quicker recovery compared to the older techniques. In fact, most patients now go home the next day or the day after that.
Often, the surgeon will remove a small piece of fat from just below the skin on the abdomen to fill the cavity created by the tumor removal. The bottom of the skull is sometimes reconstructed using an absorbable man-made mesh. This will help bolster the strength of the repair of the hole made in the bottom of the skull, and helps prevent leakage of cerebrospinal fluid (CSF). The CSF fluid surrounds the brain, spinal cord, and pituitary gland and acts as a cushion, and provides nutrients to the nervous system.
In a small number of patients, the fat or muscle packing will not hold and CSF may leak from the nose. If the drainage continues, it may allow bacteria into the CSF and may result in an infection called meningitis. Sometimes waiting a few days, or treatment with a small drainage tube in the lower back, will allow this drainage to stop so that no further treatment is needed. However, in a few patients (less than 2%), another procedure may be necessary to seal the hole at the bottom of the skull.