Keyhole surgery

Endoscopic Endonasal Surgery

At Pacific Neuroscience Institute, we are at the forefront of neurosurgical advancements, including the use of endoscopic endonasal surgery for the treatment of pituitary disorders. This innovative and minimally invasive surgical technique offers numerous benefits and has revolutionized the management of pituitary tumors and related conditions. In this comprehensive guide, we will explore the ins and outs of endoscopic endonasal surgery, its advantages, the procedure itself, and the expertise of our renowned neurosurgeons.

What is Endoscopic Endonasal Surgery?

Endoscopic endonasal surgery is a state-of-the-art procedure that involves accessing the pituitary gland and surrounding structures through the nasal passages, eliminating the need for traditional open surgery. This technique utilizes a high-definition endoscope, a thin and flexible tube with a light and camera, which allows surgeons to visualize and access the surgical area with precision.

The endonasal approach uses the nostrils as natural surgical corridors to remove pituitary adenomas, and many midline skull base, and brain tumors.

The endonasal route is the preferred surgical approach for almost all pituitary adenomas and Rathke’s cleft cysts, as well as most craniopharyngiomas, clival chordomas and many midline menigiomas. Utilizing high-definition endoscopy (surgical telescope), surgical navigation (“GPS for the brain”) and Doppler ultrasound for carotid artery localization, the endonasal approach has evolved into a safe and effective procedure in experienced hands. Major advantages of the endonasal route are: avoidance of brain retraction, minimal or no manipulation of the optic nerves, no facial incisions and infrequent need for nasal packing.

At the PNI, we have one of the world’s largest experiences in endoscopic endonasal skull base surgery for all types of pituitary adenomas and midline brain tumors.

By incorporating leading edge technology and instrumentation with proven surgical experience of over 2,000 endonasal surgeries, our endoscopic surgery specialists led by neurosurgeons Drs. Daniel Kelly, Garni Barkhoudarian and Walavan Sivakumar, and ENT/Otolaryngologist Dr. Chester Griffiths, strive to make pituitary surgery safer, less invasive and more effective.

Advantages of Endoscopic Endonasal Surgery

Endoscopic endonasal surgery offers several advantages over traditional approaches for pituitary disorder treatment. These include:

  1. Minimally invasive: The surgery is performed entirely through the nostrils, avoiding external incisions and minimizing trauma to surrounding tissues.
  2. Faster recovery: Patients often experience shorter hospital stays, reduced pain, and faster overall recovery compared to traditional surgery.
  3. Improved visualization: The endoscope provides enhanced visualization of the surgical site, allowing for more precise tumor removal and reduced risk to nearby critical structures.
  4. Reduced risk of complications: The risk of complications, such as infection and CSF leaks, is significantly lower with endoscopic endonasal surgery.

The Endoscopic Endonasal Surgery Procedure

Preoperative Evaluation

Before undergoing endoscopic endonasal surgery, patients will undergo a comprehensive preoperative evaluation, which may include imaging studies, hormonal testing, and consultations with our experienced neurosurgeons and endocrinologists. This thorough assessment ensures personalized treatment plans tailored to each patient’s specific needs.

Surgical Technique

During the surgery, the patient is placed under general anesthesia. The neurosurgeon, assisted by an otolaryngologist, navigates the endoscope through the nostrils to access the pituitary gland and surrounding areas. Advanced instruments and techniques are used to remove or treat the pituitary tumor or other underlying conditions, while preserving normal pituitary gland function.

Postoperative Care and Recovery

Following endoscopic endonasal surgery, patients are carefully monitored in the recovery area before being transferred to a hospital room. Our dedicated healthcare team provides comprehensive postoperative care, managing pain, monitoring hormone levels, and addressing any potential complications. Patients typically experience a smoother recovery, with most being able to return to normal activities within a few weeks.

Tumors Accessible by the Endoscopic Endonasal Approach

The endonasal approach is not ideal for approaching all midline tumors. In some patients, an alternative minimally invasive route such as the supraorbital eyebrow craniotomy or a conventional craniotomy may be recommended.

Our Surgical Experience

Our Center Director, Dr. Daniel Kelly has one of the world’s largest endoscopic endonasal transsphenoidal surgery experiences with over 2000 patients treated, including over 800 fully endoscopic surgeries and an academic track record of over 50 publications related to endonasal surgery and pituitary hormonal disorders. Our team has extensive experience with patients who have had prior surgery or other treatments for a pituitary adenoma and other skull base tumors.

Together with Dr. Chester Griffiths, BTC Chief of Endoscopic Sinonasal & Skullbase Surgery, they have over 40 years of experience in endonasal surgery. Dr. Garni Barkhoudarian is fellowship–trained in endonasal endoscopic skull base neurosurgeon and an expert in pituitary disorders, skull base tumors and endoscopic keyhole surgery. See our full surgical video library.

Appointments and Consultations

For a consultation or second opinion regarding possible endonasal surgery with Dr. Kelly, Dr. Barkhoudarian please click here. We will get back to you within 24 hours.

Click here for appointment instructions and new patient questionnaire. Please provide us with your most recent relevant medical records including diagnostic imaging (e.g., MRI, CT), blood tests and prior consultations. If some tests have not been done, we can help you arrange these as well. Your information can be faxed to 310-582-7495 or mailed to:

Daniel F. Kelly, MD & Garni Barkhoudarian, MD
Pacific Pituitary Disorders Center

Saint John’s Health Center
Saint John’s Cancer Institute
2200 Santa Monica Blvd
Santa Monica CA, 90404

Written and reviewed by:
We are a highly specialized team of medical professionals with extensive neurological and cranial disorder knowledge, expertise and writing experience.
Last updated: March 1, 2024