Endoscopic transnasal transsphenoidal surgery for pituitary tumours
What is Endoscopic Transnasal Transphenoidal Surgery?
Endoscopic transnasal transsphenoidal surgery is a minimally invasive technique performed to remove pituitary region tumours by inserting an endoscope through the nose. An endoscope is a long tube with a camera attached at the end that sends images to a computer screen for the surgeon to view inside the body. It is generally performed by a Neurosurgeon and an Ear Nose throat (ENT) Surgeon working together.
When is Endoscopic Transnasal Transphenoidal Surgery Recommended?
Endoscopic transnasal transsphenoidal surgery can be utilised to remove pituitary region tumours which are compressing critical brain structures or are oversecreting certain hormones.
How Should I Prepare for Transnasal Transphenoidal Surgery Recommended?
- Attend appointments with the ENT surgeon
- Attend appointments with and endocrinologist
- Attend appointments with an eye specialist
- Discuss the procedure, risks, benefits, and expected outcomes with your surgical team.
- Sign consent form.
- Attend all preoperative appointments and imaging studies.
- Inform your doctor about medications, allergies, and medical conditions.
- Stop certain medications, such as blood thinners, supplements, and fish oil.
- Follow fasting instructions carefully.
- Arrange transportation and support for recovery.
What Happens During Endoscopic Transnasal Transphenoidal surgery?
What Happens After Endoscopic Transnasal Transphenoidal Surgery?
After surgery, patients are monitored in the intensive care unit for 1-2 days for complications such as excessive urine output, bleeding from the nose, or leakage of brain fluid. Pain medications, anti-nausea medication and steroids are prescribed. Imaging scans are performed the next day to exclude complications. Blood tests are performed daily to assess for hormonal imbalance. Recovery on the ward varies between 2-5 days. It is essential that you do not cough, sneeze or blow your nose for 4 weeks after surgery. Nasal packs may be in place that will be removed by the ENT team after discharge.
What are the benefits Endoscopic Transnasal Transphenoidal Surgery?
The resection of the pituitary adenoma through endoscopic transnasal transsphenoidal surgery has several benefits over open surgery, which include
- No external incisions and no visible scars
- Minimal loss of blood
- Faster healing and recovery time.
What are the Risks and Complications of Endoscopic Transnasal Transphenoidal Surgery?
As with any surgery, endoscopic transnasal transsphenoidal resection of pituitary can be associated with certain risks and complications, which include:
- Diabetes insipidus (excessive urine production due to lack of a pituitary hormone)
- Cerebrospinal fluid leak through the nose, which may require further surgery and/or insertion of a lumbar drain (tube inserted into the lower spine to drain CSF)
- Nasal deformity and bleeding
- Pituitary gland damage
The following 2 complications are theoretically possible but are extremely rare:
- Loss of vision due to damaged optic nerves
- Injury to carotid artery causing massive, life-threatening haemorrhage or stroke
What can I expect when I am discharged from hospital
- You may experience pain (including headache), inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Refrain from sneezing and blowing your nose until your follow up visit (4-6 weeks)
- Instructions on nasal sinus care and will be provided.
- Refrain from smoking and alcohol until your first follow up visit as it can negatively affect the healing process.
- Refrain from lifting anything heavier than 5 Kg and other strenuous activities until the first follow-up visit. These activities may include housework, yard work, gardening, mowing, etc.
- Gentle exercise and regular walking are recommended to improve strength and endurance from 2 weeks after surgery.
- Refrain from driving until you are fully fit and receive your surgeon’s clearance.
- Most patients can return to their normal daily routines in 4-6 weeks after surgery.
