The pituitary gland is a small yet extraordinarily important structure located at the very centre of the brain, at the base of the skull, responsible for regulating the body’s hormonal balance. Pituitary adenomas — tumours that develop within this gland — are most commonly benign, yet they can give rise to serious complaints including headaches, visual disturbances, and hormonal imbalances.
Technological advances in contemporary neurosurgery have brought patients a considerably more comfortable and safer treatment journey. At the forefront of these advances stands the endoscopic endonasal, or minimally invasive, approach.
What Is the Endoscopic Endonasal Technique?
Endoscopic endonasal pituitary surgery is, in brief, an operative technique performed entirely through the nostrils, without any incision or suturing. During the procedure, a high-resolution camera — an endoscope — along with specialised surgical instruments, is advanced solely through the nasal passages. There is therefore no external intervention whatsoever to the brain or the face.
Compared with traditional open surgical techniques, this approach offers patients a number of significant advantages.
There is no external skin incision, meaning no scarring remains on the face or scalp. Brain tissue is not manipulated, as the tumour is reached via the shortest and most natural anatomical route. The hospital stay is brief, with most patients able to be discharged within two to three days of surgery. Recovery is faster, allowing patients to return to daily life in a short time. Tumour visualisation is clearer, as the endoscope enables the surgeon to see the operative field at high magnification and from a wide angle.
Who Is a Suitable Candidate for This Surgery?
The great majority of patients diagnosed with a pituitary adenoma can be treated by this method. In particular, large tumours causing visual field deficits — known as macroadenomas — tumours that secrete excess hormones such as those seen in acromegaly, Cushing’s disease, and prolactinoma, and cases that have not responded adequately to medical therapy are all considered primary candidates for endoscopic endonasal surgery. Every patient is unique, however, and the surgical decision is planned on an individual basis following detailed radiological imaging, hormonal investigations, and clinical assessment.
How Does the Preoperative Process Work?
Before surgery is planned, the patient must undergo a comprehensive evaluation. This process involves several components.
MRI — Magnetic Resonance Imaging — is used to determine the size and location of the tumour and its relationship to the surrounding structures. Hormonal investigations assess the functional status of the pituitary gland and establish whether the tumour is secreting hormones. An ophthalmological examination evaluates the visual field and optic nerve. An endocrinology consultation ensures specialist coordination in cases where hormonal treatment is required.
In light of all these findings, the surgical team plans the operation in the safest and most effective manner possible.
What Should Be Expected After Surgery?
In many patients, a noticeable improvement in headaches and visual complaints begins in the immediate aftermath of surgery. Normalisation of hormonal levels may occur over weeks to months depending on the type and size of the tumour.
There are several points requiring attention during the postoperative period. Vigorous nose-blowing and suppressing sneezes should be avoided until healing within the nasal cavity is complete. Regular MRI scans and hormonal check-ups should be carried out at defined intervals. Should any change in existing complaints arise or new symptoms develop, a physician should be consulted without delay.
Modern Technology, More Comfortable Treatment
When performed with the correct indication and in experienced hands, endoscopic endonasal pituitary surgery delivers highly successful outcomes. This approach — leaving no incision scar, causing no damage to brain tissue, and allowing rapid recovery — is today recognised as the gold standard in the treatment of pituitary adenomas.
Every individual who has received or suspects a diagnosis of pituitary adenoma should be evaluated by a neurosurgeon with specific expertise in this area. Early diagnosis and correct timing directly influence both the success of surgery and the patient’s quality of life.
Do not hesitate to ask every question you have. Being well informed is the most powerful partner in your treatment.
Prof. Dr. Mehmet Şenoğlu — Specialist in Neurosurgery, İzmir
This article has been prepared for general informational purposes only and does not replace medical examination, diagnosis, or treatment. For any complaints, please consult your specialist physician.