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Transsphenoidal Surgery For Pituitary Tumors

WHAT YOU SHOULD KNOW:

Transsphenoidal Surgery For Pituitary Tumors (Inpatient Care) Care Guide

  • Transsphenoidal surgery for pituitary tumors is surgery to remove a tumor (lump) on the pituitary gland. Pituitary tumors form when cells grow and divide without control. These cells often make too much tissue and affect structures close to the pituitary gland. The pituitary gland is a small pea-sized gland that produces different hormones (chemicals). These hormones keep your body working properly. The pituitary gland is located behind the sphenoid sinus (air spaces). It lies between the eyes, behind the bridge of the nose, and just below the brain.

  • In a transsphenoidal approach, three different routes may be taken to reach the pituitary tumor. The entry point may be through an incision (cut) made under the upper lip and over the teeth. It may also go directly through the nostrils or through an incision made on the nasolabial furrow. The nasolabial furrow is the line or wrinkle between the side of the nose and the cheek. All these approaches reach the pituitary gland through an opening made on the sphenoid sinus.

  • Once the incision is made, caregivers will insert small tools and an endoscope to remove the pituitary tumor. An endoscope is a metal tube with a light and tiny video camera on the end. This gives caregivers a clear view of the nose and brain area while watching the images on a monitor. With a transsphenoidal surgery, the pituitary tumor may be removed and symptoms relieved.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Problems may happen during your transsphenoidal surgery for your pituitary tumor that may lead to a craniotomy (open brain surgery). Your brain, eyes, other bones and organs, blood vessels, or nerves may get injured while having the surgery. You could also get an infection, or bleed too much. Your hormone levels may suddenly change and cause serious problems. Your caregivers will give you medicines and watch you closely if this happens. Even after a having surgery, there remains a chance that your tumor may not be completely removed.

  • After surgery, you may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.

  • Without treatment, a pituitary tumor may grow and push other structures near it. If this happens, there is a danger that the blood or nerve supply may be cut off. You may have problems seeing, breathing, or thinking clearly. This may lead to other serious medical problems, such as blindness or stroke. Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

  • Endotracheal (ET) tube: An endotracheal tube may be put into your mouth or nose. It goes down into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.

During your surgery:

  • Facial hair and some of the hair on your head may be shaved. Soap and water will be used to clean your head and face. Sheets will be put over you to keep the surgery area clean. Your head will be placed on a small pillow and may be slightly tilted towards your left shoulder.

  • An incision will be made on the left nasolabial furrow, inside your nosebridge, or on your upper gums. Using an endoscope, caregivers will go through your nasal passages to reach the sphenoid sinus. The sphenoid sinus is a hollow structure and its back wall covers the pituitary gland. Retractors, forceps, or a small chisel will be used to open the walls of the sphenoid sinus. The pituitary tumor is exposed and then removed using the endoscope and other small tools.

  • The openings and incisions are then closed with stitches. A nasal packing will be inserted in the nostrils to prevent bleeding. A bandage is placed to cover your incisions.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is okay. When caregivers see that you are okay, you will be taken back to your hospital room. You may need to breathe through your mouth until the nasal packings are removed by your caregiver. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound. Ask your caregiver for more information about ways to prevent bleeding and take care of your incision.

  • Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Medicines: You may need any of the following:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.

    • Hormone replacement medicines: These medicines replace certain hormones normally produced by the pituitary and other glands.

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

  • Monitoring: Caregivers may check for your pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

    • Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

  • Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

  • Oxygen and a ventilator: You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal tube (ET tube) in your throat. Oxygen can be given through the ET tube by a breathing machine called a ventilator. After the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short, thin tubes in your nose).

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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