Endoscopic Skull Base & CSF Leak Surgery

Providing exposure to the pituitary gland and base of the brain, and repairing damage done by trauma or surgery to these areas are part of what Rhinologists – Otolaryngologists do. We work closely with various neurosurgeons in the community in Atlanta to assist in pituitary gland surgery (adenohypophysectomy) and definitively sealing cerebrospinal fluid (CSF) leaks that come from these areas.

CSF leaks may result spontaneously in the case of a thinned skull base or in the condition of pseudotumor cerebri. Most commonly the leaks result from prior surgery or trauma to the skull base (the area at the bottom of the brain just above the eyes and sinuses). These leaks come from small tears in the sack lining the brain. Watery, salty fluid can spill from the brain cavity in the the nose and down the throat. Bending over, straining, or exercising makes the problem worse. While a CSF leak will cause a deep sharp headache and possibly ringing of the ears, its most serious consequence can be a life-threatening meningitis. Our surgeons are trained in CSF leak evaluation and treatment. We work in collaboration with neurosurgeons for the most serious cases.

Pituitary gland surgery is performed primarily by neurosurgeons, but often with our assistance. The most contemporary method is a procedure to fully open the sphenoid sinus behind the eyes with our usual sinus surgical instruments. The top and back wall of the sinus is then carefully opened allowing exposure of the pituitary gland and surrounding brain structures. Operating on this gland (and in fact several other nearby conditions). After the gland or other tumor has been removed we work to thoroughly seal the opening so no leakage of spinal fluid can occur.

Usually patients are watched in the hospital for a couple days after surgery to ensure no issues regarding bleeding, leaking, or hormonal imbalance occur.