Performed with a combination of neurosurgeons and ENT surgeons, a transsphenoidal procedure consists of an approach through the nose and sphenoid sinus to remove pituitary tumors. The surgery can be performed with the use of a microscope or an endoscope for more minimal invasive techniques, known as endoscopic endonasal surgery. The traditional skin incision is performed, as well as tiny bone openings through the nasal septum, sinus, and sella in order to reach pituitary. After removal of the tumor, the sella is then sealed up with bone graft located from the septum. Synthetic grafting material may be used in place due to lack of bone graft.