Transsphenoidal surgery is performed to remove pituitary tumors, which are abnormal growths that develop in the pituitary gland. Pituitary tumors cause a variety of hormone problems and can grow large enough to compress important nerves and arteries of the brain. Most pituitary tumors are noncancerous and usually remain confined to the gland and surrounding tissues rather than spreading to other parts of the body as cancerous tumors might. Surgery may not be the first option for pituitary tumors and your doctor will focus on controlling its growth and managing your hormone levels with medication.
Pituitary tumors can cause hormone problems and vision loss, so removal of these tumors often restores hormonal balance and reverses vision problems. For small lesions, transsphenoidal surgery has a lower chance of brain injury and fewer side effects than a craniotomy.
-Less postoperative discomfort
-Shorter period for recovery and return to normal activity
-Fewer risks for neurologic injury -Excellent outcomes.
-The risks that may come with the surgery
Here’s what you can expect during surgery:
1. You will get an Intravenous (IV) that will allow the doctors to give you fluids and medicine through your vein during and after the surgery.
2. A doctor will give you a general anesthesia. This means that you will be asleep during the surgery.
3. You will probably have a catheter (tube) inserted into your bladder. This will allow the doctors to carefully monitor your fluids and urine output.
4. Once you are asleep, your surgeon will insert the small tube (endoscope) into your nose through your sphenoid sinus to your pituitary gland. This will help them see a wider area around your gland.
5. Your surgeon will have to remove a small piece of thin bone at the base of your skull to reach the pituitary gland. They will then make a small incision (cut) to get to the tumour or cyst.
6. Using special instruments, your surgeon will try to remove the tumour or cyst without disturbing the normal pituitary gland
The surgery usually lasts from 2 to 4 hours. The length depends on; the size of the tumour or cyst, the area it covers and the difficulty in removing it.
Your doctor will discuss with you about your condition, the procedure and the risks that may come with it. You may also have to meet an anesthesiologist, an endocrinologist, a pharmacist to discuss your past history and any potential risks that may occur. The tests that you may likely need to take include; blood tests, X-rays, ECG. Your doctor will tell you to not eat or drink anything after midnight on the day of your surgery. You may be able to take some medicines the morning of your surgery.
When you wake up from the operation, you will initially be in close monitoring and once your overall condition is stable, and you are relatively awake and responsive, you will be transferred to your neurosurgical ward or high dependency unit. You will probably need to breathe through your mouth; this can be quite frightening initially but you will soon relax and find that you will manage this well. You will probably have a sore, painful nose. It can depend on how the operation goes, as to whether any packing in your nose is necessary. The length of time this remains in place depends on the individual’s surgery and is dictated by the surgeon, but in general, this will be removed within the first couple of days. This can be uncomfortable, but is performed quickly and you can have painkillers if required. Initially, you will have your vital signs monitored frequently i.e. blood pressure, pulse and temperature. You will be attached to a cardiac monitor and have an intravenous infusion of clear fluids and oxygen therapy. Initially, you will be questioned frequently to ensure you are alert mentally.
Your doctor will discuss the risks of the surgery with you. While the risks of this type of surgery are low, they can include: -A change in the way your pituitary gland works -A leak of a fluid called cerebrospinal fluid (CSF) from your nose -Infection -Nose bleeds (this can happen early after surgery or later on) These problems are very uncommon and often temporary. Approximately 2 or 3 out of 100 patients who have the surgery will have complications. It is important to understand the risks and ask your surgeon questions if you have any concerns.
Will there be much pain or discomfort after surgery?
Most patients experience mild to moderate discomfort for several days after surgery. The amount of discomfort varies from patient to patient, with some requiring only mild pain medications for a day or two whereas a minority of patients require pain medications for several weeks. We will make every effort to minimize your discomfort.
What does my pituitary gland do?
Your pituitary gland is an important structure in the brain. It produces many different hormones (types of body chemicals) that are critical for survival. These hormones are very important for your body’s: growth, development, sexuality, reproduction, and metabolism. Your pituitary gland stores the hormones and releases them at the right time. Tumours or cysts in or around the gland can affect the function of the gland. These tumours can also press against other structures like optic (eye) nerves, which can affect your vision. Pituitary tumours can cause a variety of symptoms. The common symptoms include vision problems or symptoms associated with hypo-secretion (too little production) of the pituitary hormones. Another symptom can also be hyper-secretion (too much production) of one of the hormones. This can cause conditions such as acromegaly or Cushing’s disease. Your surgeon will discuss your particular situation in detail with you.
How long will it take me to recover?
It usually takes about 2 to 6 weeks to recover from the surgery. But it can take up to 3 months for some people to feel like their normal self again. Everyone’s recovery time will be different.
How should I care for my nose when I get home?
There are some things you can do to help you heal and recover more quickly. It is important to keep your nose clean and moist while you heal. Use only a normal saline nasal spray to moisten inside your nostrils. Don’t put any creams, ointments or objects into your nose. To clean your nostrils: -Spray each nostril with the saline spray at least 5 times a day or more -Do this for at least 3 to 4 weeks Using saline spray keeps hard crusts from forming in your nose. These hard crusts can slow your healing and block your breathing. Using saline spray will also reduce bad odours from your nose which sometimes can happen after this type of surgery. If you have on-going bad odours from your nose and a lot of congestion (stuffy nose) one month after surgery, continue to use your nasal spray and talk with your ENT or your neurosurgeon. Your smell may be affected for the first few weeks after surgery. This is normal and will be temporary.