A form of neurosurgery, Transsphenoidal surgeries use an endoscope, and other surgical instruments, to enter the brain through the nose, the sphenoid bone, and the sphenoidal sinus cavity.
What is it?
Most commonly transsphenoidal surgeries are used to remove pituitary gland tumors. Because of the complexity associated with transsphenoidal operations, Neurosurgeons work alongside other specialists to safely and efficiently remove pituitary tumors. Despite their inherent complexity, endoscopic surgeries do not require external incisions. By passing instruments through the nasal cavity and into the skull through a small hole in the sphenoidal sinus, surgeons effectively remove pituitary tumors without the need for open brain surgery. Instead, incisions are made in the nasal septum, sphenoid sinus, and the sella turcica to reach the pituitary gland. The sella turcica is the bone directly in front of the pituitary gland.
What should I do to prepare?
Patients meet with various specialists to discuss the surgery and schedule pre-surgical diagnostic tests. MRI scans on the day before or the day of surgery are required. Certain medications may need to be stopped, and the patient cannot take NSAIDs for at least a week before surgery. It is suggested patients stop using tobacco products for one to two weeks before surgery.
What happens during the process?
The patient will be given general anesthesia for this surgery. Imaging equipment is then placed on the patient’s head to direct the surgeons as they proceed with the operation. After insertion, the endoscope is directed up the patient’s nostril where a small incision is made in the nasal septum. Then, the sphenoid sinus is cut to access the sella turcica. After removing the sella turcica, the surgeon gently breaches the Dura, the protective layers immediately covering the brain, and begins excising the tumor. If a tumor is not completely removed through surgery, any remaining cancerous cells are treated with radiation therapy. Following pituitary tumor excision, the hole in the sella turcica is repaired using synthetic grafts or glue.
What are the risks and potential complications?
Some risks and complications associated with this procedure can include sinus infections, excessive bleeding, cerebrospinal fluid leak, anesthesia complications, nerve damage, and artery damage.
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