Endoscopic TNTS cost in India

Know More About Procedure & Surgery

What is Endoscopic Surgery?

Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope camera and light to remove tumors with long instruments. Pituitary tumors can cause hormone problems and vision loss. Tumor removal often reverses vision problems and restores normal hormone balance.

What is transsphenoidal pituitary surgery?

Transsphenoidal literally means “through the sphenoid sinus.” It is a surgery performed through the nose and sphenoid sinus to remove pituitary tumors. Transsphenoidal surgery can be performed with an endoscope, microscope, or both. It is often a team effort between neurosurgeons and ear, nose, and throat (ENT) surgeons.

Patients with following ailments are advised to undergo TNTS surgery:

• Pituitary adenoma (tumor in the pituitary gland)
• Meningioma (tumor in the membrane that surrounds the spinal cord and brain)
• Craniopharyngioma (intracranial tumors)
• Chordoma (a rare cancerous tumor that occurs in the bones of the spins and skull)
• Rathke's Cleft Cyst (a cyst between the posterior and anterior lobes of pituitary gland).

During Surgery

This surgery performed under general anesthesia which is given to patient through intravenous line. The nasal cavity is then prepared through antiseptic and antibiotic solutions. The surgeon navigates through the nose with the help of an image guided system that is attached to the patient's head during surgery. Now the surgeon inserts and endoscope in one of the nostrils and routes it to the back of the nasal cavity. He is able to view the internal structures with the help of camera attached to the endoscope. Then, with the help of instruments, the surgeon removes a small section of the nasal septum and opens the front wall of sphenoid sinus. The thin bone of Sella, which is the bone overlying at the back wall of sphenoid sinus, is also removed so that the dura (tough lining of skull) is visible. Now the tumor and pituitary gland is accessed through an opening in the dura. Another instrument called curette is used through the other nostril for removing tumor in pieces.

After the complete removal of tumor, the surgeon inspects the sella area for any hidden tumor. Any small portion of the tumor that is left and cannot be removed is treated later through radiation therapy. After the surgery is complete, the surgeon closes the sella opening. There might be a need of fat graft to fill the empty space created after the removal of tumor. This fat is taken from abdominal area. Now a cartilage graft is used for closing the hole in sella. Use of biologic glue over the graft helps in preventing the leakage of cerebral spinal fluid from the brain to nasal cavity. Bleeding, swelling and adhesions are controlled by use of flexible soft splints. Medicines are given to control the common symptoms of nausea, headache and nasal congestion after surgery. Patient can be discharged after another 1 to 2 days of hospital stay.

Recovery

Patient may feel exhausted and have headache and nasal congestion for 2 to 3 weeks after surgery. This will steadily improve in few weeks time. The decongestants given by your treating doctor will relieve the above symptoms.

• Getting back to normal life or work commonly takes around 2 weeks, depending upon the patient's condition.
• Start walking gradually after discharge from the hospital.
• Strictly avoid blowing your nose, sneezing, coughing or bending over in order to prevent any internal injury to the surgical site.
• Do not drive for at least 10 to 14 days or unless approved by your treating doctor.
• Taking bath should not be a problem after surgery, but make sure to avoid any strain to the brain or nasal area during bathing.
• Follow up visit is required after one week of surgery so that splints can be removed and surgical area can be inspected by the doctor.
• Cross consultation with endocrinologist and ENT doctor will also be required.

Treating doctor needs to be contacted in case of below mentioned complications:

• Any kind of nasal drainage or swelling
• Excessive bleeding or nasal congestion
• Difficulty in breathing
• High fever
• Severe headache or neck pain
• Increase in urine output, or extreme thirst or weight loss.

Risks involved in the surgery

Some of the risks involved in this surgery are:

• Damage to the normal pituitary gland,
• Diabetes insipidus caused due to damage to the posterior portion of pituitary gland,
• Loss of vision
• Leakage of CSF (Cerebro Spinal Fluid) which can also lead to meningitis,
• Nasal deformity
• Stroke due to damage to the cavernous sinuses and carotid arteries.

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