Endo-nasal endoscopic surgery is the most modern surgical approach for Pituitary and related skull base tumors. This novel surgical techqnique is safer, less invasive and more effective. Most neurosurgeons around the world have transitioned from a traditional microscopic approach using one nostril to an endoscopic-assisted or to a fully endoscopic binostril approach and hence this method is more popular and adopted now-a-days
The operation utilizes both nostrils with two surgeons operating together with three or four hands to hold the endoscope and surgical instruments. This binostril technique which incorporates a wide opening into the sphenoid sinus (sphenoidotomy), allows excellent instrument and endoscope maneuverability to remove pituitary adenomas and other types of skull base and brain tumors. The magnified visualization with the light source within the sphenoid sinus gives a high-definition display of the normal and pathological anatomy, improving the ability to remove both small tumors hidden within the gland and large tumors that extend into surrounding spaces such as the cavernous sinus.
This endoscopic approach also allows preservation of a great majority of the nasal mucosa which promotes rapid healing, preservation of sense of smell and a generally rapid recovery. This approach negates the use of relaxing incisions in the nostril. The incidence of lip and teeth numbness is essentially absent.
offers advantages for improved outcomes in the removal of pituitary adenomas, and select midline skull base and brain tumors. These advantages include:
Notably, for some brain and skull base tumors, a trans-cranial keyhole approach such as the supraorbital eyebrow route or a more traditional craniotomy may be required
In summary, the endonasal endoscopic transsphenoidal approach for pituitary tumor removal is generally a safe and highly effective alternative to the previously utilized microscopic-based surgical approaches. The endoscopic approach provides superior visualization of the pituitary and parasellar anatomy and allows for a wider exposure and increased degrees of freedom for tumor removal. In general endoscopy allows greater extent of tumor resection especially for larger and more invasive tumors. The incidence of complications
is low provided that operations are performed by an experienced pituitary surgery team at a facility that performs a relatively high volume of pituitary tumor operations.