Who is a Candidate?
You have been experiencing headaches, sinus pain, double vision, and nausea for some time now. You didn’t think much of these symptoms at first. However, when you had a seizure, you sought medical help immediately.
After an MRI, your primary physician determines that your symptoms were caused by a tumor called a pituitary adenoma, which puts pressure on the pituitary gland. The pituitary gland is a part of the brain that makes hormones.
Your tumor does not secrete hormones. This is why you didn't notice any hormonal changes. However, some pituitary adenomas make hormones and cause different types of symptoms based on the hormones they produce. For instance, Cushing syndrome is one of many possible results of such a tumor. This disease is characterized by weight gain around the midsection, thinning of the limbs, and thinning skin.
As terrifying as this news seems, you are relieved to learn that your tumor can be removed with transnasal tumor resection surgery. This procedure is used to remove various sorts of tumors.
If you have one of the following tumors, you are a suitable candidate for the surgery:
Functioning pituitary adenoma (hormone-secreting)
Non-functioning pituitary adenoma (non-hormone-secreting)
Cancerous tumors (treated with surgery, radiation, and cancer medication)
Non-secretory, benign tumors smaller than 10 mm often don’t require surgery and can be treated with medication.
What to Do Before the Surgery
Before the surgery, you will have an office meeting with a neurosurgeon, an ENT surgeon, and an endocrinologist. Here, you will discuss the risks and benefits of the procedure and be given a list of medications.
One week before the operation, you will need to stop taking anti-inflammatory drugs, like ibuprofen, and blood thinners. Alcohol and nicotine should also not be consumed for 7 days before the surgery.
You will be admitted to the hospital on the morning of the surgery. Because you will be put under general anesthesia, you will have to stop eating, drinking, and chewing gum at midnight before the operation.
How is a Transnasal Tumor Resection performed?
Once you are put under anesthesia, the ENT surgeon inserts an endoscopic tube into your nostril. This tube is then pushed deeper into the nose until the bony wall of the sphenoid sinus, located at the back of the nose, is reached. Next, this wall is opened, allowing the endoscope to pass through the back wall of the sinuses. Another small opening is made here, allowing the surgeon to access the pituitary gland. The neurosurgeon then removes the tumor in small pieces. Once the tumor is removed, the endoscope is taken out of your nose, and the openings are closed.
What are the risks?
The success rate of this procedure ranges from 60 to 90%, making it a relatively safe operation. However, like with every surgery, there are risks that must be taken into consideration.
Meningitis (infection of the brain membrane)
Cerebrospinal fluid ( fluid surrounding the brain) leaks (may require additional surgery)
Damage to the pituitary gland (causes hormone secretion; may need hormone replacement therapy)
Damage to large blood vessels (can cause heavy bleeding)
Damage to optic nerve (can cause vision problems)
How Does the Recovery Process Look?
Your surgery was successful!
You spend the first two days post-surgery in the hospital. You experience severe headaches for a few days, which is normal, and you are prescribed pain medication.
To avoid infection and bleeding, you follow these guidelines:
Refrain from blowing your nose for two weeks post-surgery.
Avoid heavy lifting, bending, or straining on the toilet to minimize the risk of nasal bleeding or cerebrospinal fluid leakage.
Sleep in a recliner or with 2-3 pillows; ensure ample rest, and maintain normal eating and drinking habits.
Avoid swimming with your head underwater for three months to reduce infection risk.
Pace movement with frequent rest periods; gradually increase activity levels as your endurance improves.
Avoid heavy household tasks for eight weeks following surgery.
Do not fly for two months post-operation.
Return to work (usually 2-4 weeks; 6 weeks if it's an active job) and driving only when your surgeon deems you fit.
Call Your Doctor If:
Clear fluid with a metallic taste drips from your nose or throat.
You experience vision loss or double vision.
You have persistent nose bleeding.
You have extreme thirst or frequent urination.
You have a fever over 101.5° F that doesn't respond to Tylenol.
You have increased drowsiness, confusion, nausea, vomiting, or headache.
You notice signs of incision infection.
You have a rash or itching at the incision site.
You experience swelling and tenderness in one calf.
You have a seizure.
What is the Further Treatment?
Functioning pituitary adenomas are cured 60 to 90% of the time after surgery, depending on the type of hormones released. However, if symptoms persist after surgery, hormone replacement therapy may be used to relieve them.
After a cancerous tumor is removed, radiation and chemotherapy may be used to fight the disease.
In your case, no further treatment is needed because your symptoms were caused by pressure on the pituitary gland and surrounding nerves. These symptoms disappeared with the removal of the benign tumor.
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