Endoscopic Endonasal Surgery

What is endoscopic endonasal surgery?

Endoscopic endonasal surgery is a minimally invasive technique that allows a surgeon to go through the nose to operate on areas at the base of the brain and the top of the spine.

A thin tube called an endoscope is thread through your nostril, nose, and sinuses. This gives your surgeon access to parts of your brain that would be hard to reach using traditional surgical approaches that often require large incisions and removal of parts of the skull.

Why might I need endoscopic endonasal surgery?

Endoscopic endonasal surgery can be used to remove tumors in areas near the base of the brain or skull, and at the top of the spine. It can also be used to treat problems with the sinuses. This approach allows the surgeon to reach these areas without the need for large incisions or removal of parts of the skull. This often makes recovery quicker and less painful.

What are the risks of endoscopic endonasal surgery?

Any major surgery carries some risk. Most people get through this surgery and heal without problems. But complications can develop. Possible risks include:

• Reactions to the anesthesia

• Excessive bleeding

• Hematoma (a pooling of blood in the wound site)

• Damage to veins, arteries (carotids), nerves (especially those that control vision and eye movements), and other structures in the area

• Cerebrospinal fluid (CSF) leaking from the nose

• Infection including meningitis

• Slow healing

• Blood clots

• Pneumonia

The procedure may carry other risks, depending on your specific health condition. Talk about any concerns with your surgeon before the procedure.

How do I get ready for endoscopic endonasal surgery?

You will be under general anesthesia for this surgery. That means you will be asleep and won't feel anything. If you have any questions about the anesthesia or about any other aspect of the procedure, be sure to ask your medical team in advance.

You can increase the chances for success by preparing correctly. In general, presurgery preparation involves these steps:

• If you smoke, quit at least 2 weeks before your surgery. This will make anesthesia more successful and help with healing.

• Don't take over-the-counter pain relievers for 2 weeks before your surgery. This includes common products like aspirin and ibuprofen.

• Don't take vitamin E for 2 weeks before the surgery.

• Make sure to tell your healthcare provider about any medicines you are taking, any other health problems you have, and any problems you've had with previous operations or anesthesia.

• Follow any directions you are given for not eating or drinking before surgery.

• You should arrive for surgery at least 2 hours before your procedure or as instructed by the surgery center. Check in at the admissions desk to fill out any necessary forms, including a consent form that must be signed before the surgery can begin.

Your surgical team will give you more specific directions to follow before the procedure. Some of these might be slightly different from those listed above.

What happens during endoscopic endonasal surgery?

You will be asked to change out of your clothes and into a gown. A nurse will start an intravenous (IV) through which you will get fluids and medicine during the procedure. You might be given a sedative to help you relax. After you have spoken with the anesthesiologist and your surgeon, you will be given the anesthesia that will let you sleep through the operation.

During the procedure, your surgical team will thread a thin tube through your nose and sinuses to shine a light and a camera on the spot where they need to operate. The camera relays images to a monitor in the operating room during the surgery. Specially designed tools will also be inserted through the nose to drill bone, stop any bleeding, cut out and remove tumors or other problem areas.

Some steps might be slightly different from those outlined above. Talk with your healthcare team about what might happen during your procedure.

What happens after endoscopic endonasal surgery?

After your operation, your nose and sinuses may be packed with bandages. These are usually removed within a week after the surgery. You also will be given antibiotics to fight infection. If you feel pain or discomfort, let your healthcare providers know. Most people spend 1 to 2 days in the hospital before going home.

Once you are discharged, take any prescriptions you are given as instructed and follow all postoperative instructions.

Call your healthcare provider right away if you are confused about how to take the recommended medicines.  Get medical care right away if any of the following occur:

• Pain and headaches that can't be managed with prescribed medicines

• Fever of 100.4˚F (38˚C), or higher, or as advised by your provider

• Shaking chills

• Redness, tenderness, heat, or pus, which are signs of infection, at the surgery site

• Swelling in the area around the nose

• Shortness of breath or trouble breathing

• Chest pain

• Any clear and salty tasting drainage from the nose, especially when sitting or standing

Your healthcare team may give you other instructions about what you should do after your procedure.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure