Transsphenoidal Pituitary Surgery

Transsphenoidal surgery removes a pituitary tumour through the nose. The surgeon passes instruments through the nostrils and the sphenoid sinus, an air space behind the nose, to reach the pituitary gland at the base of the brain without opening the skull. There are no cuts on the face.

It relieves pressure on the optic nerves and can normalise excess hormone production. Remission rates are about 80 to 90 percent for small hormone-producing tumours and lower for large or invasive ones. Tumour that has grown into the cavernous sinus beside the gland often cannot be removed safely and may need medication or radiosurgery afterwards.

What Transsphenoidal Pituitary Surgery involves

The work-up consists of a dedicated pituitary MRI, a full hormone profile, and formal visual field testing when the tumour is near the optic chiasm. Under general anaesthetic, an endoscope is passed through one nostril, usually by an ENT surgeon working with the neurosurgeon. The opening of the sphenoid sinus is widened, the partitions inside it are removed, and the thin bone covering the pituitary fossa is opened. The dura is cut and the tumour, which is typically soft, is removed piece by piece with ring curettes and suction, while the normal gland is identified and preserved. Angled endoscopes let the surgeon check hidden corners. If spinal fluid leaks, the defect is sealed with fat, fascia or a flap of nasal lining. Navigation is often used.

Who is a good candidate for Transsphenoidal Pituitary Surgery?

Decisions are best made by a pituitary team of endocrinologist, neurosurgeon and ENT surgeon.

• Macroadenomas pressing on the optic chiasm and causing visual field loss
• Cushing disease and acromegaly, where surgery is the first-line treatment
• Prolactinomas that do not respond to or cannot tolerate cabergoline
• Growing non-functioning adenomas
• Pituitary apoplexy with visual loss, as an emergency, and Rathke cleft cysts or some craniopharyngiomas

It is usually not the right choice if:

• Most prolactinomas, which shrink with tablets
• Small non-functioning tumours found by chance, which are monitored
• Tumours extending far sideways or up into the brain, which may need an open or combined approach
• Active sinus infection, until treated

Technique options

• Endoscopic endonasal approach: Wide, angled view. Now the most common method.
• Microscopic transsphenoidal approach: The long-established technique using an operating microscope and nasal speculum; results are comparable in experienced hands.
• Extended endoscopic approach: Removes additional bone to reach tumours above or beside the fossa.
• Adjuvant radiosurgery or medication: For residual or recurrent tumour.

What happens during your treatment

Surgery takes 2 to 4 hours under general anaesthetic. Afterwards, the team measures your urine output, sodium and cortisol closely. Your nose feels blocked and you may have a headache for a few days. Hospital stay is 3 to 5 nights.

Preparing for your trip

Plan for 10 to 14 days in Istanbul. Your surgeon reviews photographs and your medical history before you book, and you meet in person the day before surgery for examination, marking and consent with a professional interpreter.

• Stop smoking and nicotine at least four weeks before and after surgery; it is the single biggest avoidable cause of wound problems
• Tell the team about every medicine and supplement you take; blood thinners, some herbal products and hormone treatment may need to be paused on your doctor's advice
• Arrange for someone to travel with you or to be reachable, and keep the first days at home free of work and lifting
• Book a changeable return flight; your surgeon confirms when you are fit to fly

Recovery and results

Do not blow your nose, strain or bend forward for 3 to 4 weeks, and sneeze with your mouth open. Saline rinses start when your surgeon advises. Tiredness is common for 2 to 4 weeks. A sodium blood test about a week after surgery is important, because a delayed fall can cause nausea and confusion. Hormones are retested at 6 weeks and MRI repeated at 3 months. Stay in Istanbul for about 10 to 14 days, and have an endocrinologist at home ready to take over.

• Back to everyday activity: 3 to 4 weeks
• When results show: Vision may improve within days; hormone results at 6 weeks
• How long they last: Usually lasting; recurrence in roughly 10 to 20 percent over 10 years

Safety, risks and revision policy

In high-volume pituitary units, serious complications are uncommon.

• Diabetes insipidus, with excessive urine and thirst, usually temporary
• Low sodium about a week after surgery
• New underactivity of the pituitary needing hormone replacement
• Spinal fluid leak from the nose, with a risk of meningitis
• Nosebleed, crusting, sinusitis or altered smell
• Worsened vision or double vision, rarely
• Injury to the carotid artery, which is very rare but serious
• Residual or recurrent tumour

Every written proposal arranged through Clinic-Y states what the clinic covers if a correction is needed. Ask for it before you book, not after.

Cost of Transsphenoidal Pituitary Surgery in Türkiye

Clinic-Y does not publish a single price for Transsphenoidal Pituitary Surgery, because the honest figure depends on your case. What moves it:

• Tumour size and invasiveness
• Two-surgeon endoscopic team and navigation
• Hormone testing and MRI before and after
• Intensive monitoring nights
• Hormone replacement or further treatment if needed

Send your photographs or reports and you receive written, all-inclusive proposals from suitable teams, side by side. Reviewing your case is free.

Frequently Asked Questions