Overview: The endonasal endoscopic approach uses the nostrils as natural surgical corridors to remove tumors of the pituitary gland, midline skull base and undersurface of the brain, thereby avoiding or minimizing brain and cranial nerve manipulation.

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 very 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 the rare need for nasal packing. 

Disorders Treated:The endonasal approach is used for virtually all pituitary adenomas (acromegaly, Cushing’s disease, prolactinomas, non-functional adenomas, pituitary apoplexy), and Rathke's cleft cysts, as well many midline skull base and brain tumors including craniopharyngiomas, clival chordomas, sphenoid sinus carcinomas and olfactory neuroblastomas. It is also used to remove or debulk midline meningiomas of the tuberculum sella, petroclival and cavernous sinus regions.  The endonasal route, however, is not ideal for all midline tumors and in some patients, an alternative minimally invasive route such as the supraorbital eyebrow craniotomy or a conventional craniotomy may be recommended.

Our Experience and Approach: BTC Director, Dr. Daniel Kelly has one of the world’s largest endonasal transsphenoidal surgery experiences with over 1,500 patients treated, including over 600 endonasal endoscopic surgeries and an academic track record of over 50 publications related to endonasal surgery and pituitary hormonal disorders. Together with Dr. Chester Griffiths, BTC Chief of Endoscopic Sinonasal & Skullbase Surgery, they have over 40 years of experience in endonasal surgery.

Our new BTC Neurosurgeon, Dr. Garni Barkhoudarian is fellowship–trained in endonasal endoscopic skull base surgery and an expert in pituitary disorders.

Multidisciplinary Care:For patients with pituitary adenomas and other related tumors such as craniopharyngiomas and Rathke’s cleft cysts, hormonal monitoring and hormonal replacement may be required.  Collaboration with an endocrinologist is thus always recommended. Some patients with incompletely removed or aggressive tumors may also require radiosurgery or stereotactic radiotherapy. To learn more about our comprehensive approach for patients with pituitary tumors, go to Pituitary Disorders Program.

See more: Endoscopic & keyhole surgery videos on BTC YouTube Channel  

For a consultation or second opinion regarding possible endonasal surgery with Dr. Kelly, Dr. Barkhoudarian or one of our other specialists, please call our office (310-582-7450) or e-mail us with an inquiry (braintumor@stjohns.org).

Click here for Appointment Instructions & 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
Brain Tumor Center & Pituitary Disorders Program
Saint John’s Health Center
John Wayne Cancer Institute
2200 Santa Monica Blvd
Santa Monica CA, 90404

Phone: 310-582-7450
Fax: 310-582-7495
Email: kellyd@jwci.org   barkhoudariang@jwci.org