Hi Betty, I don't think they 'break the skull' in transphenoidal surgery. I believe they have to break a small bone in the nose in order to enter the sinus cavity and then access the pituitary, there of course they have to cut open the pituitary to 'harvest' the tumour cells, the likelihood of damaging the pituitary gland, if it is still there, happens at that juncture and it depends on the skill of the neurosurgeon. Because you are talking of limited space and visibility, hence the experience and skill of the neurosurgeon becomes so important. I think Minnie was right to say even transphenoidal through the nose is differently done in the hands of different surgeons. It seems the fully endorscopic one 'markets' on the concept that they don't have to break anything, because there is no metal tube (speculum?) involved, just a slender endoscope!! But one neurosurgeon told me it wasn't really that great, because the blood always gets into the way and the wiper at the tip of the endoscope cannot get rid of all the blood, the vision was dangerously unclear and they have to take it out to clean it and reinsert again!! Another neurosurgeon said he recent went to Germany where some of the top pituitary neurosurgeons all over the world came together to learn from each other and one top German neurosurgeon showed how he would work on a patient. He used endoscopic assisted transphenoidal through the nose. The endorscope showed no tumour cells were left. Then the patient was put inside an intraoperative MRI - sure enough, there they found unresected tumour cells!! Here we are talking about top specialist pit neurosurgeons. May be the story to learn is: go for the neurosurgeon who uses intra-operative MRI. I think this is still an area where there is still a lot unkown..... Oldmanfore | 