Transsphe­noidal Pitu­itary Surgery (2008)

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The Patient’s Guide to Transsphe­noidal Pitu­itary Surgery

Con­tents

1. Why you should read this pam­phlet
2. The Pitu­itary Gland
3. Pitu­itary Tumours
4. Transsphe­noidal pitu­itary surgery
5. Health care pro­fes­sion­als that will treat you
6. Before the surgery
7. Dur­ing the surgery
8. After the surgery
9. Going Home
10. Activ­ity restric­tions after the surgery
11. Med­ica­tions
12. Warn­ing Signs
13. Go to the Emer­gency Depart­ment right away if you
14. Fol­low up care
15. Who to call with your ques­tions or con­cerns
16. Addi­tional Resources & Information


1. Why you should read this pamphlet

The pur­pose of this book­let is to pro­vide you with infor­ma­tion about transsphe­noidal pitu­itary surgery, and to explain what the health care pro­fes­sion­als in the hos­pi­tal can offer you. It is impor­tant for you to feel con­fi­dent and com­fort­able about your surgery.

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2. The Pitu­itary Gland

The pitu­itary gland is a small, pea-​sized gland found at the base of your brain, just above the back of your nose. The pitu­itary gland is the “mas­ter gland”. It releases hor­mones and chem­i­cal sig­nals to other parts of your body. These hor­mones con­trol many dif­fer­ent things in your body such as sex­ual devel­op­ment, men­stru­a­tion, thy­roid and cor­ti­sol (a nat­ural hor­mone) func­tion and growth.

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3. Pitu­itary Tumours

Pitu­itary tumours are com­mon. They are usu­ally benign or non-​cancerous. Because of a pitu­itary tumour, the pitu­itary gland may not work prop­erly. The tumour may cause the pitu­itary gland to make too many or too few hor­mones. The pitu­itary tumour might push on other parts of the brain or blood ves­sels. This pres­sure can cause prob­lems such as headaches and changes in vision.

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4. Transsphe­noidal pitu­itary surgery

Your doc­tor may tell you that surgery to remove the tumour is the best treat­ment for you. The most com­mon surgery to remove a pitu­itary tumour is called “transsphe­noidal surgery”. Transsphe­noidal means that the surgery is done through the sphe­noid sinus. Hav­ing the surgery done through your nose is the most direct way to reach the tumour with­out touch­ing the brain. This kind of surgery does not usu­ally leave a scar.

The tumour is usu­ally removed using a micro­scope or an endo­scope (a fine telescope).

By per­form­ing surgery, your doc­tor is hop­ing to stop the symp­toms that you have been hav­ing and to con­trol the hor­mone lev­els in your body

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5. Health care pro­fes­sion­als that will treat you

ImageDur­ing your stay in the hos­pi­tal, there will be many health care pro­fes­sion­als that will treat you. The pro­fes­sion­als that are involved in your care will depend on your indi­vid­ual needs. Here is a list of some of the many health care pro­fes­sion­als that may work with you dur­ing your stay in the hospital:

Neu­ro­sur­geon and Otorhi­no­laryn­gol­o­gist
Neu­ro­sur­geons spe­cial­ize in surgery on the brain; spine and other parts of the ner­vous sys­tem and otorhi­no­laryn­gol­o­gist are sur­geons with exper­tise in surgery of the nasal sinuses. The neu­ro­sur­geon and the otorhi­no­laryn­gol­o­gist will be the doc­tors that will per­form the surgery on your pitu­itary tumour.

Endocri­nol­o­gist
Endocri­nol­o­gists spe­cial­ize in dis­eases that affect your glands and the hor­mone pro­duc­tion in your body. The endocri­nol­o­gist will give you dif­fer­ent tests or treat­ments to help you have a healthy bal­ance of hor­mones in your body.

Clin­i­cal Nurse Spe­cial­ist (CNS)
The clin­i­cal nurse spe­cial­ists (CNS) are there to help you and your fam­ily through­out your treat­ment. These are spe­cial­ized nurses that are highly trained. They are avail­able to answer any ques­tions that you might have. You should con­tact the clin­i­cal nurse spe­cial­ist if you have any con­cerns before, dur­ing or after your surgery.

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6. Before the surgery

ImageYour doc­tors will ask for some tests to be done before your surgery. You may need to have an MRI (mag­netic res­o­nance imagery) or a CT scan (com­put­er­ized axial tomog­ra­phy). These tests will tell your doc­tors exactly where the tumour is. Your doc­tor may also test your eyes to see if they are being affected by the tumour.

Your doc­tor will ask you to come to the hos­pi­tal for a pre-​admission visit. At this visit, a nurse will ask you ques­tions about your health. Your nurse will also help to pre­pare you for surgery. This visit will take sev­eral hours. You may have other tests done. These tests might be blood tests, x-​rays, or an ECG (electrocardiogram).

The endocri­nol­o­gist may ask you to have blood tests and urine tests to check your hor­mone levels.

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7. Dur­ing the surgery

The surgery usu­ally takes about 4 hours. Your fam­ily mem­bers may wait in the wait­ing room on the 4th floor, room 486. The doc­tor may want to talk to your fam­ily after the surgery.

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8. After the surgery

ImageYou will be moved from the oper­at­ing room to the recov­ery room when the surgery is fin­ished. As you recover you will be moved from the recov­ery room to a care unit. You will stay in the hos­pi­tal for 3 to 7 days.

In the first 3 days after the surgery the nurses will watch you very closely. The nurses will ask you ques­tions to see if you are not feel­ing well. They will watch your blood pres­sure, heart rate, breath­ing and vision.

After the surgery, you may have a catheter (tube) in your blad­der to mea­sure how much urine your body makes each hour. This tube will usu­ally stay in your blad­der for 23 days. You will have an IV (intra­venous) in your arm. The nurses will mea­sure how much you are drinking.

The doc­tor may have made a small cut on your stom­ach to get a small piece of fat. This piece will have been put in the place where the tumour was. The cut may hurt slightly or make you uncomfortable.

If your surgery was done through your nose, you will have some cot­ton packed in your nose. This will be there for 13 days. You may need to breathe through your mouth and your mouth may feel dry and uncom­fort­able. Using a moist air mask may help to keep your mouth moist. Drink­ing will also help.

Your senses of taste or smell may be less than nor­mal. This should improve in the next cou­ple of months.

As much as pos­si­ble try not to sniff, cough or sneeze. If you do sneeze keep your mouth open. DO NOT BLOW YOUR NOSE.

If you feel any salty or sug­ary liq­uid drip­ping in the back of your throat or any watery liq­uid drip­ping from your nose, tell the nurse.

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9. Going Home

You may have a sinus headache and nasal con­ges­tion. This will improve over a few weeks.

If your mouth becomes dry, take small sips of water often. Lip balm or Vase­line® can help dry lips.

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10. Activ­ity restric­tions after the surgery

After the surgery you may feel weak and tired. This feel­ing will last for a cou­ple of weeks. You should have many rest peri­ods dur­ing the day.

You may go back to your usual activ­i­ties slowly. Try to walk a lit­tle bit more each day. Do not stay in one posi­tion. Your doc­tor will talk with you about lifestyle changes that are spe­cific to you.

You may shower and wash your hair after your surgery.

You may fly in an air­plane after your surgery.

Dur­ing the six weeks fol­low­ing your surgery you should grad­u­ally return to your nor­mal activ­i­ties. Here is a list of activ­i­ties you should NOT do before 6 weeks.

  • Return­ing to work
  • Bend­ing, strain­ing or lifting
  • Sneez­ing, cough­ing, blow­ing your nose
  • Aer­o­bic exercising
  • Swim­ming

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11. Med­ica­tions

ImageAfter the surgery, the hor­mones in your body may not return to nor­mal. If you are miss­ing some hor­mones, your doc­tor may give you some med­ica­tions to replace them. The endocri­nol­o­gist will watch the hor­mone lev­els in your body.

You should keep tak­ing your reg­u­lar med­ica­tions unless your doc­tor tells you to stop. Before you leave the hos­pi­tal you should learn about the med­ica­tions that you are tak­ing and about any side effects. Take a list of med­ica­tions that you are tak­ing to every visit with your doctor.

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12. Warn­ing Signs

ImageProb­lems rarely occur after leav­ing the hos­pi­tal, but it is impor­tant to be aware of abnor­mal signs and symp­toms that might occur.

Call your doc­tor or clin­i­cal nurse spe­cial­ist if you:

  • Start bleed­ing from your nose (don’t worry about a lit­tle bit of blood stained mucus)
  • Have changes in your vision like if you are see­ing dou­ble, if you can’t see nor­mally or if light both­ers you.
  • Have neck pain.
  • Have a tem­per­a­ture higher than 38 degrees Cel­sius or 100 degrees Fahrenheit.
  • Have a smell com­ing from your nose.
  • Have a headache that is get­ting worse.
  • Are always thirsty.
  • Have to go to the bath­room more than you did before your surgery.
  • Feel dizzy or lightheaded.
  • Are faint­ing.

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13. Go to the Emer­gency Depart­ment right away if you:

  • Feel water drip­ping from your nose that won’t stop
  • Are very drowsy or hard to wake up
  • Feel con­fused
  • Feel rest­less
  • Have nau­sea or if you are vomiting


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14. Fol­low up care

  • You will have a follow-​up appoint­ment with the endocri­nol­o­gist in 6 to 8 weeks. Do not stop tak­ing your med­ica­tion before this appointment.
  • You will also have a follow-​up MRI, a visual field eye test if your vision was affected before surgery, and an appoint­ment with your sur­geon in about 3 months.
  • An eye doc­tor (oph­thal­mol­o­gist) may fol­low you after the surgery.

If you have any ques­tions, please call us.

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15. Who to call with your ques­tions or concerns

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Day time: Mon­day to Friday

  • Brain Tumour Clinic: (514)3985937
  • Clin­i­cal Nurse Spe­cial­ists
    • Yas­min Khalili
      • Clinic: (514) 3985937
      • Office: (514) 3981966
    • Maria Hamaki­o­tis
      • Clinic: (514) 3985937
      • Office: (514) 3986644 local 089817

After 4:30pm (16h30)
EMER­GEN­CIES ONLY
Neu­ro­surgery Res­i­dent: dial (514) 9341934 local 53333 and ask “locat­ing” to have the neu­ro­surgery res­i­dent on call paged. Emer­gen­cies only please.

Dis­claimer Infor­ma­tion
Impor­tant. Mate­ri­als pro­vided by the Resource Cen­tre are for edu­ca­tional pur­poses only, they are not intended to replace the advice or instruc­tion of a pro­fes­sional health­care prac­ti­tioner, or to sub­sti­tute for med­ical care.

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16. Addi­tional Resources & Information

Infor­ma­tion about InfoNEURO
Neuro-​Patient Resource Cen­tre
Mon­treal Neu­ro­log­i­cal Hosp­tial Room 354
Tel: (514) 3985358
E-​mail: infoneuro@​muhc.​mcgill.​ca
Web site: http://​infoneuro​.mcgill​.ca/

This infor­ma­tion is for edu­ca­tional pur­poses only, and is not intended to replace the advice of a pro­fes­sional health­care prac­ti­tioner, or to sub­sti­tute for med­ical care.

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Devel­oped by Maria Hamaki­o­tis, and Yas­min Khalili, Clin­i­cal Nurse Spe­cial­ists of the MUHC Brain Tumour Clinic team and Eileen Beany Peter­son and Michelle Brown Librar­i­ans of the Neuro-​Patient Resource Cen­tre.
Reviewed and revised by Dr. Richard Leblanc, Neu­ro­sur­geon, Head, MUHC Brain Tumour Clinic team.
Pro­duced by the the Neuro-​Patient Resource Cen­tre 2008.


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