What it is
Endonasal pituitary surgery is performed entirely through the nostrils. Using an endoscope and specialized instruments, the surgeon travels through the nasal cavity and sphenoid sinus to reach the pituitary gland, which sits in a bony compartment called the sella turcica at the base of the skull. The tumor is removed through this corridor, leaving no external incision and causing no disruption to the brain.
This approach has largely replaced the older microscopic sublabial (under the upper lip) technique and is now the standard at centers with endoscopic skull base experience.
What to expect
Most patients are admitted the night before surgery and stay one to two nights afterward. A lumbar drain is sometimes used temporarily to reduce CSF pressure during healing. The most common side effects in the early recovery period are nasal congestion and temporary changes in taste or smell. Endocrine function is carefully monitored after surgery, as the normal pituitary gland surrounding the tumor can be affected.
The team
Endonasal pituitary surgery is best performed as a collaborative operation between neurosurgery and ENT/rhinology — each contributing specific expertise. Endocrinology guides pre- and postoperative hormone management. Ophthalmology tracks visual field recovery.
Outcomes
Hormone-secreting tumors (acromegaly, Cushing disease, prolactinoma) have variable biochemical remission rates depending on tumor size and local invasion. Non-functional tumors causing visual symptoms typically show meaningful visual improvement after decompression if surgery is performed before the compression is long-standing. Recurrence is possible with incompletely resected or aggressive tumors and is managed with radiation or re-operation.