Transsphenoidal Adenomectomy- This is the name of the surgeries I had

I thought that I would take a minute to explain what kind of surgery that is required when you have a pituitary tumor. The surgery is called Transsphenoidal adenomectomy. This surgery is a very delicate procedure and should only be done by a specialist.

The termd "transsphenoidal" means through the spenoid. Sphenoid is part of the sinus. This is how the surgeon gains access to the pituitary gland which is located at the base of the brain.

Risks:

There are obviously risks involved with this surgery (as with all surgeries). The most common risks include infection of the lining of the brain (which is called meningitis), heavy bleeding from the incision, and reaction to the anesthetic used during the surgery. Other risks that are less common include leakage of the cerebrospinal fluid from the brain (which is what happened to me during my first surgery), problems with fluid balance and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Although these complications are serious they are all treatable.

Before Surgery:

Before a person has this surgery the patient meets with the surgeon and an anesthesiologist to discuss the surgery, possible complications and answer any questions that the patient may have. Once you have met with them and you fully understand the surgery and possible complications the patient is then asked to sign a consent form. This is to state that the patient fully understand the process. Also they should tell you to practice breathing through your mouth because after the surgery your nostrils will temporarily be blocked and you will have to be comfortable breathing through your mouth. The night before the surgery you are not allowed to eat or drink anything.

What Happens During Surgery:

During this surgery you will be placed under a general anesthetic. This will keep you asleep during the operation. 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. Your head is also placed in a headrest to ensure that your head is kept still during the surgery. The surgeon uses a special microscope and very fine instruments to approach the pituitary gland through a nostril or an opening made below the upper lip (in my case both times it was through my nose). The surgeon has to get through the nose and the sphenoid bone (a butterfly-shaped bone at the base of the skull). This allows the surgeon access to the pituitary gland. The tissue covering the pituitary gland will be cut open. The surgeon uses special instruments to remove the tumor. Once the tumor is removed the bottom of the pituitary chamber will be replaced with bone that was removed earlier during this procedure. The incicion will be closed, and the nostrils will be packed with gauze or a special nasal sponge. Sometimes a small piece of fat will be removed from another part of your body (for me the first time it was taken from my leg, and the second time it was taken from my abdomen) and packed into the pituitary chamber. This is done to help prevent brain fluid from leaking.

After Surgery:

Immediately after the surgery the patient is taken to an area where they will monitor you until you are ready to be taken to your patient care unit. Normally you would stay in patient care for 2-5 days, as long as there are no complications.

If there are not complications your bed will be positioned and raised slightly (30 degrees). This is done to promote blood flow from your head and to decrease pressure in your head. If you have to have a spinal drain (like after my first surgery) you will have to lie completely flat. Normally your nose will be packed with nasal packing for 1-3 days. You will have to breathe out of your mouth during this time. The nasal packing is uncomfortable and may cause headaches. Sometimes the packing is needed to stay in longer. When the packing is removed there will be some bleeding and drainage from your nose. The discharge should subside within a few days. You will not be able to blow your nose, drink from a straw or sneeze for at least 6 weeks following your surgery.

Lumbar Drain:

If you have to have a lumbar drain inserted following your surgery it is inserted into your lower back. The catheter is placed into your spinal canal. The lumbar drain is used to allow fluid to flow away from the incision so that it can heal. Usually the drain is left in for 3-5 days following surgery. You have to lie flat on your back while the drain is in your spine, however you are allowed to turn onto your side.

Activity after surgery:

You must be careful for a while after your surgery about what you do for activity. It is especially important not to cough, sneeze, bend over, blow (or pick) your nose, or strain for at least a month. This will allow everything to heal properly, and prevent future complications.

It is important to remember that every individual is different so recovery make take longer or shorter. A big part in recovery is thinking positively. A positive outlook speeds up recovery time!