Transsphenoidal Surgery For Pituitary Tumors

What you should know

• 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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medications. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• You may need to take certain hormone replacement medicines. Ask your caregiver for more information on how to take them properly.
  
  
• You may need to have a computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, chest x-ray, and blood tests. As your caregiver for more information about these tests. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given a pill to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses. Wear socks to help you stay warm.
  
  
• If you are staying in the hospital after your surgery, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery.
  
  
• You may be asked to brush your teeth and gargle with antiseptics many times.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved into a special bed. 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. Caregivers may give a general anesthesia to make you sleep during surgery. An endotracheal tube connected to a breathing machine may be put into your windpipe to keep your airway open and help you breathe during your surgery.
  
  
• An incision will be made on the left nasolabial furrow, inside your nosebridge, or on your upper gums. Retractors, forceps, or a small chisel may be used to open the walls of the sphenoid sinus. The coverings of the brain are then cut and opened. 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 bandage is placed to cover your incisions to control the bleeding. Nasal packings may also be placed in your nostrils.

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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have questions or concerns about your surgery.
  
  
• You have a fever.

Seek Care Immediately if

• You have a sudden severe headache.
  
  
• You have trouble seeing, breathing, speaking, or thinking clearly.
  
  
• You passed out or had a convulsion.
  
  
• Your face is getting numb or you cannot move your arms or legs.

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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.