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Endoscopic endonasal surgery: reaching a tumour through the nose | CION Cancer Clinics
Endoscopic endonasal surgery removes a tumour at the base of the skull by working up through the nostrils, with a thin camera and long, fine instruments. There is usually no cut on the face or scalp. It suits tumours that sit in the middle, behind the nose and sinuses, but not those that spread far out to the sides. This page explains the operation, the first weeks at home and the warning signs. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is endoscopic endonasal surgery?
- What happens during the operation?
- Who is this route suitable for, and who is it not?
- What do the words in your notes mean?
- What are the first weeks at home like?
- What do families often believe about surgery through the nose?
- Common questions about endoscopic endonasal surgery
The short answer
What is endoscopic endonasal surgery?
It is an operation to remove a tumour from the floor of the skull by going up through the nose. The surgeon passes a thin camera, called an endoscope, into one or both nostrils and works with long, fine instruments beside it, watching a screen.
Why the nose is used as a doorway
Many skull base tumours sit in the middle of the head, behind the nose and sinuses, just under the brain. The nose and sinuses form a natural corridor to that spot. Going through them means the surgeon does not have to lift the brain or open the skull from above to see the tumour. For the right tumour, that usually means no cut on the face and a shorter stay in hospital.
Which tumours it is used for
It is used for some cancers of the nose and sinuses that have reached the skull base. It is also used for chordoma, a slow-growing bone tumour at the centre of the skull base, and for pituitary tumours, which are usually not cancers. Your scans decide whether this route can reach all of the tumour safely.
Inside the theatre
What happens during the operation?
Asleep and still
You are given a general anaesthetic, so you are fully asleep. Your head is held very still. Many teams use a navigation system, which works like a map showing the surgeon exactly where the instruments are on your scans.
Opening the corridor
The surgeon widens the path through the nose and sinuses, removing thin bone and sometimes part of the partition between the nostrils. An ear, nose and throat surgeon and a neurosurgeon often work together, one steering the camera while the other operates.
Removing the tumour
The tumour is taken out, in pieces if needed, and sent to the laboratory. The aim is a clear margin, meaning a rim of healthy tissue with no cancer at the edge. Next to vital nerves and blood vessels that is not always possible.
Sealing the gap
The opening left in the skull base is closed in layers, often with a flap of lining from inside your nose. Soft packs or splints may be left in the nose. This seal is what stops fluid from around the brain leaking out.
Not sure whether this applies to you?
Ask an oncologistChoosing the route
Who is this route suitable for, and who is it not?
The choice rests on where the tumour sits and how far it has spread, not on which method sounds gentler.
Often suitable
Tumours in the middle of the skull base, directly above or behind the nose and sinuses, that do not spread far out to the sides.
Typical examples
- Some sinus cancers reaching the skull base
- Bone and cartilage tumours near the centre
- Pituitary tumours
Often not suitable
Tumours that spread sideways beyond the eye socket, grow into the skin of the face, or wrap around the large blood vessels to the brain. The camera cannot safely reach round every corner.
Sometimes combined
Some tumours need both routes: part removed through the nose and part through a cut on the scalp or face. This can be one operation or two, planned in advance.
When surgery may not come first
For some tumours, radiotherapy or chemotherapy is used first or instead. Your treating team decides this after reading the biopsy and scans together.
This page cannot tell you whether your tumour can be reached this way. Only your scans, read by the surgical team, can.
!
Clear fluid dripping from the nose after you go home
A thin, watery drip from one nostril, especially when you lean forward, can be fluid from around the brain leaking through the repair. So can a salty taste at the back of the throat. A severe headache, fever, stiff neck or confusion can mean infection of the brain lining. Call your surgical team or go to an emergency department the same day. Do not wait to see whether it stops, and do not blow your nose.
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In your notes
What do the words in your notes mean?
- Endoscope
- A thin tube with a light and camera at its tip. It shows the inside of your nose and skull base on a screen.
- Skull base
- The floor of the skull, the bone the brain rests on. The eyes, nose and ears sit just beneath it.
- CSF (cerebrospinal fluid)
- The clear, watery fluid around the brain and spinal cord. A CSF leak means this fluid is escaping.
- Nasoseptal flap
- A strip of lining from the partition inside your nose, turned over to patch the opening in the skull base.
- Lumbar drain
- A thin tube in the lower back that drains some CSF for a short time. Some teams use it to take pressure off the repair.
Going home
What are the first weeks at home like?
Your nose will feel badly blocked for several weeks. That is expected. It comes from crusting, swelling and any packs or splints, not from the tumour.
Things your team will usually ask
Most teams ask you not to blow your nose, strain on the toilet, lift heavy things or bend with your head low for a while. Sneeze with your mouth open. These rules protect the repair while it heals, and your surgeon will tell you how long they apply to you.
Smell, taste and crusting
Your sense of smell is often weaker for a time and may not fully return, especially if the flap came from the area that picks up smells. Salt-water rinses and clinic visits to clear crusts are common. Tell the team if crusting becomes painful or smells bad.
Hormones and eyesight
If the tumour was near the pituitary gland, which controls many of the body's hormones, you may need blood tests and hormone tablets for a while. Report any change in your eyesight.
Commonly believed
What do families often believe about surgery through the nose?
"No cut on the face means it is a small operation."
The way in is small, but the work inside is not. The operation can take many hours, often involves two surgical teams and carries real risks, including fluid leaks, bleeding and injury to the nerves of the eye.
"Through the nose must always be better than open surgery."
Neither route is better in general. Each suits a different kind of tumour. Choosing the nose for a tumour it cannot fully reach could leave cancer behind. Ask your surgeon why this route was chosen for your scans.
"If the nose stays blocked for weeks, something has gone wrong."
A blocked, crusted nose is the normal course of healing after this surgery. The signs that do need attention are a clear watery drip, fever, a severe headache and changes in eyesight.
"Once the tumour is out, no more treatment is needed."
Many people need radiotherapy afterwards, depending on what the laboratory finds in the removed tissue. Follow-up scans continue for years. The pathology report guides this, which is why the full plan is often confirmed only after surgery.
Questions we are asked
Common questions about endoscopic endonasal surgery
Will there be any scar on my face?
Usually not. Everything is done through the nostrils, so the skin of the face is not cut. If fat or a tough tissue layer is needed for the repair, it may be taken from the thigh or tummy, leaving a small scar there.
How long will I stay in hospital?
It depends on the size of the tumour and how the repair was done. Many people stay several days, and some spend the first night in intensive care for close watching. Ask your team what they expect for you before the operation.
Will I lose my sense of smell?
Smell is often weaker after surgery, and for some people it does not come back fully. It depends on how close the tumour and the repair were to the top of the nose, where smells are picked up. Ask your surgeon before the operation whether your sense of smell is at particular risk.
Can the whole tumour be removed this way?
Sometimes, and sometimes not. A tumour touching the nerves to the eyes or the main blood vessels may have to be left in part, because removing all of it would cause serious harm. Your team will tell you what they aim to remove, and whether radiotherapy is planned for anything left behind.
When can I travel home to my district?
Flying and long, bumpy journeys put pressure on the repair, so most teams ask you to wait a while. Travel by car is often allowed sooner than flying. Check with your surgeon before booking anything, and carry your discharge summary and the team's phone number with you on the way.
Is this operation covered by Aarogyasri or insurance?
Skull base surgery for cancer may be covered under Aarogyasri, CGHS, ECHS, EHS or cashless insurance when it is part of an approved treatment plan. Limits and paperwork differ between schemes. Call the helpline with your card details and reports, and the team will check your cover before admission.
What should I ask my surgeon before agreeing?
Ask why the nose route suits your tumour, whether an open or combined approach was considered, and who will do each part. Ask how the opening will be sealed, what happens if fluid leaks, and whether radiotherapy is likely afterwards. Bring a family member who can write the answers down.
What are the main risks?
They include a fluid leak through the repair, infection of the brain lining, bleeding, loss of smell and, less often, damage to the nerves that control eyesight and eye movement. Hormone problems can follow surgery near the pituitary gland. Ask your surgeon how often these happen in their own practice.
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Dr. C. Raghavendra Reddy
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- National Cancer Institute — Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ) - Patient Version
- National Cancer Institute — Pituitary Tumors Treatment (PDQ) - Patient Version
- NHS — Nasal and sinus cancer
- Cancer Research UK — Nasal and sinus cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Open vs endoscopic skull base approachesHow the team chooses between the nose and the scalpCSF leak after skull base surgeryThe complication behind the red flag on this pageReconstruction of the skull baseHow the opening is sealed after the tumour is outVision and eye movement after skull base surgeryWhat to watch for when the tumour is near the eye nervesSkull Base and Temporal Bone ResectionEvery page in this guide
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