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Transsphenoidal surgery

Transsphenoidal surgery is performed through the nose and sphenoid sinus to remove tumors from the pituitary gland and skull base, and it can be performed with an endoscope, microscope or both. The transsphenoidal approach, which is the most common technique of endoscopic endonasal surgery, is often a joint effort between neurosurgeons and ear, nose and throat (ENT) surgeons.

Why Choose UF Health

At UF Health, patients enjoy coordinated, patient-centered care from adult and pediatric neurosurgery, ENT and endocrinology.

Our patients also benefit from an experienced program that has performed over 1,100 transnasal/transsphenoidal (TNTS) operations for pituitary tumors. These procedures are carried out with state-of-the-art imaging and equipment for endoscopy.

What is the Procedure Used For?

Transsphenoidal surgery can help those suffering from one of many conditions:

  • Pituitary adenoma: a tumor that grows from the pituitary gland; may be hormone-secreting or not.
  • Craniopharyngioma: a benign tumor that grows from cells near the pituitary stalk; may invade the third ventricle
  • Rathke’s cleft cyst: a benign cyst, or fluid-filled sac, between the anterior and posterior lobes of the pituitary gland
  • Meningioma: a tumor that grows from the meninges (dura), the membrane that surrounds the brain and spinal cord
  • Chordoma: a malignant bone tumor that grows from the skull base

If you have a prolactinoma (noncancerous tumor), surgery may not be required as these tumors respond well to medication or can be monitored with periodic MRIs for potential growth.

How the Procedure is Performed

If using an endoscope, a flexible tube with a light and camera attached, the operation is less disruptive to the nose in reaching the sphenoid sinus and pituitary. Video from the endoscope’s camera is viewed on a monitor to help the surgeon throughout the procedure. Called transsphenoidal endoscopic surgery, this approach uses a small incision at the back of the nasal cavity and causes minimal disruption of the nasal tissues.

Diagram of transsphenoidal procedure

Transsphenoidal surgery done with a microscope entails removing a large portion of the septum to insert a retractor so that the surgeon can see to the sphenoid sinus and pituitary.

Both techniques call for openings to be made in the nasal septum, sphenoid sinus and sella to gain access to the pituitary. Once the pituitary is exposed, the neurosurgeon removes the tumor. An image-guidance system with an accompanying 3D computer-generated map can be used to help surgeons navigate through the nose.

Benefits of the Procedure

Pituitary tumors can cause hormone problems and vision loss, so removal of these tumors often restores hormonal balance and reverses vision problems. For small lesions, transsphenoidal surgery has a lower chance of brain injury and fewer side effects than a craniotomy.

As a minimally invasive procedure, the patient benefits from:

  • Less postoperative discomfort
  • Fewer complications
  • Shorter period for recovery and return to normal activity
  • Fewer risks for neurologic injury
  • Excellent outcomes

Transsphenoidal surgery is especially recommended for children, where it is essential to retain anatomic and functional integrity to ensure normal growth and nasoesphenoidal ventilation.

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