Rhinologists (sinus surgeons) and skull base neurosurgeons work together to remove pituitary tumors through the nose using small cameras known as endoscopes. This is known as the transsphenoidal approach, or TSA. After performing sinus surgery for access, the surgical team opens the sphenoid sinus, removes the mucosa from the lining of the sinus, and removes the bone over the sella turcica. Once the bone is removed, the dura overlying the pituitary is opened, and the tumor is resected. If there is a CSF leak, it is repaired with a nasoseptal flap in addition to other graft materials. In this video, there is no cerebrospinal fluid and therefore a repair with a free mucosal graft from the middle turbinate is appropriate. The endoscopic endonasal approach is an ideal way to access pituitary microadenomas and macroadenomas in addition to other lesions such as Rathke’s cleft cysts and craniopharyngiomas.
A patient with a pituitary tumor may present with vision loss, a visual field defect, or hormone irregularities. The pituitary is a critical component of the hormonal axis of the body, affecting numerous systems. To safely access the tumor, the team uses surgical landmarks and intraoperative navigation to guide dissection.
Satish Govindaraj, MD Chief of Rhinology; Vice Chair of Clinical Affairs, Department of Otolaryngology – Head and Neck Surgery Mount Sinai Health System Associate Professor, Otolaryngology, and Neurosurgery Icahn School of Medicine at Mount Sinai
Daniel Alicea Delgado, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Mount Sinai Health System
Anthony Del Signore, MD, PharmD Assistant Professor, Otolaryngology Mount Sinai Health System Director of Rhinology and Endoscopic Skull Base Surgery Mount Sinai Union Square
Alfred M.C. Iloreta, Jr., MD Assistant Professor, Otolaryngology, Neurosurgery The Mount Sinai Hospital New York Eye and Ear Infirmary of Mount Sinai Mount Sinai Morningside and Mount Sinai West
Madeleine R. Schaberg, MD Assistant Professor, Otolaryngology Mount Sinai Health System Director, Rhinology and Skull Base Surgery New York Eye and Ear Infirmary of Mount Sinai
Calvin Wei, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Mount Sinai Health System
Zachary G. Schwam, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Division of Otology-Neurotology, Lateral Skull Base Surgery Mount Sinai Health System
