What is TNTS Surgery?

Trans Nasal Trans Sphenoidal Surgery (TNTS) is the surgical approach to remove tumors from the pituitary gland, also known as pituitary adenoma. Pituitary gland is the main endocrine gland attached to the base of the brain, and it controls the functioning and growth & development of other glands in our body.

This surgery is also performed for removing tumors from the sellar region and sphenoid sinus of the skull.

During the procedure, the surgeon approaches the pituitary gland through the sphenoid sinus, the air space behind the nose, for removing the tumor. This is a remarkable approach as no external incision or scar is involved. Since the pituitary gland is approached directly through the nasal route, this minimally invasive surgery involves shorter time and patient recovers faster too. The technique for surgery entails the use of endoscopic and microscopic approaches, and because of this there is less or no risk of internal injury to the adjoining structures of the brain.

Before the surgery, a brain MRI is done to determine the type, location and size of the tumor. Based on this , a decision regarding surgical approach is taken. A multi-disciplinary team of medical and radiation oncologists and physicians also contribute in deciding the treatment line of such patients.

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 the pituitary gland).

What happens during the surgery?

Like all other major surgeries, this too is performed under general anesthesia which is given to patients through an 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 an 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 a camera attached to the endoscope. Next, with the help of instruments, the surgeon removes a small section of the nasal septum and opens the front wall of the 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 tumors in pieces.

After the complete removal of the 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 for a fat graft to fill the empty space created after the removal of the tumor. This fat is taken from the 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 cerebrospinal fluid from the brain to the nasal cavity. Bleeding, swelling and adhesions are controlled by use of flexible soft splints.

Patient is then shifted to the post op area for observation and monitoring of vitals. Usually after an overnight stay, shifting to ward is done. Medicines are given to control the common symptoms of nausea, headache and nasal congestion after surgery. Patients can be discharged after another 1 to 2 days of hospital stay.

Transsphenoidal Surgery Recovery , post op care and follow up

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

Read below for important points to be taken into consideration during recovery period:

• 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 a 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 an endocrinologist and ENT doctor will also be required.

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

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 (CerebroSpinal Fluid) which can also lead to meningitis,
• Nasal deformity
• Stroke due to damage to the cavernous sinuses and carotid arteries.

These risks can be avoided by pre discussion with your treating doctor and following the instructions completely. The expertise of surgeons in handling such pituitary operations and well discussed planning between patient’s family and doctor, before going ahead with the surgical procedure can lead to great outcomes.

TNTS Surgery in India

TNTS surgery in India is performed by some of the best neurosurgeons in the world. The cost of TNTS surgery in India is lower than what it would cost in developed countries.

The success rate of TNTS surgery in India is very high, with patients often achieving full recovery within a few weeks. The surgeons at top hospitals in India for TNTS surgery have years of experience performing this type of surgery and are well-equipped to handle any complications that may arise.

Patients from all over the world come to India for pituitary gland surgery due to the high quality of care and low cost. If you are considering this type of surgery, you should definitely consult with a surgeon at a top hospital in India, and let us help you in planning your treatment in India.