This surgery is also performed for removing tumors from the sellar region and sphenoid sinus of the skull.
During the procedure, surgeon approaches the pituitary gland through sphenoid sinus, the air space behind the nose, for removing tumor. This is a remarkable approach as no external incision or scar is involved. Since pituitary gland is approached directly through the nasal route, this minimally invasive surgery involves shorter time and patient recovers faster too. The technique for surgery entails the use of endoscopic and microscopic approaches, and because of this there is less or no risk of internal injury to the adjoining structures of brain.
Before the surgery, a brain MRI is done to determine the type, location and size of the tumor. Based on this , decision regarding surgical approach is taken. A multi-disciplinary team of medical and radiation oncologists and physicians also contribute in deciding the treatment line of such patients.
Patients with following ailments are advised to undergo TNTS surgery:
Like all other major surgeries, this too is performed under general anesthesia which is given to patient through intravenous line. The nasal cavity is then prepared through antiseptic and antibiotic solutions. The surgeon navigates through the nose with the help of an image guided system that is attached to the patient's head during surgery.
Now the surgeon inserts and endoscope in one of the nostrils and routes it to the back of the nasal cavity. He is able to view the internal structures with the help of camera attached to the endoscope. Next, with the help of instruments, the surgeon removes a small section of the nasal septum and opens the front wall of sphenoid sinus. The thin bone of Sella, which is the bone overlying at the back wall of sphenoid sinus, is also removed so that the dura (tough lining of skull) is visible. Now the tumor and pituitary gland is accessed through an opening in the dura. Another instrument called curette is used through the other nostril for removing tumor in pieces.
After the complete removal of tumor, the surgeon inspects the sella area for any hidden tumor. Any small portion of the tumor that is left and cannot be removed is treated later through radiation therapy. After the surgery is complete, the surgeon closes the sella opening. There might be a need of fat graft to fill the empty space created after the removal of tumor. This fat is taken from abdominal area. Now a cartilage graft is used for closing the hole in sella. Use of biologic glue over the graft helps in preventing the leakage of cerebral spinal fluid from the brain to nasal cavity. Bleeding, swelling and adhesions are controlled by use of flexible soft splints.
Patient is then shifted to post op area for observation and monitoring of vitals. Usually after an overnight stay, shifting to ward is done. Medicines are given to control the common symptoms of nausea, headache and nasal congestion after surgery. Patient can be discharged after another 1 to 2 days of hospital stay.
Patient may feel exhausted and have headache and nasal congestion for 2 to 3 weeks after surgery. This will steadily improve in few weeks time. The decongestants given by your treating doctor will relieve the above symptoms.
Read below for important points to be taken into consideration during recovery period:
Treating doctor needs to be contacted in case of below mentioned complications:
Some of the risks involved in this surgery are:
These risks can be avoided by pre discussion with your treating doctor and following the instructions completely. The expertise of surgeon in handling such pituitary operations and well discussed planning between patient's family and doctor, before going ahead with the surgical procedure can lead to great outcomes.