Transsphenoidal Pituitary Tumor Resection

Transsphenoidal pituitary tumor resection is the surgical removal of a tumor located on the pituitary gland. The pituitary gland is a pea-sized gland located in the base of the skull, behind the bridge of the nose. It controls important functions in the body, including the production of chemicals that regulate certain body functions (hormones).

Pituitary tumors are rarely cancerous, and many can be treated with medicines. However, a tumor may need to be removed if it causes overproduction of certain hormones that cannot be controlled with medicine. A tumor may also be removed if it presses on nearby structures. During a transsphenoidal pituitary tumor resection, the tumor is accessed and removed through the nose and the hollow area behind the nose (sphenoid sinus). MRIs may be used to help guide the procedure.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding or a blood clot.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs, such as surrounding brain tissue.
• Scarring

The following complications are possible but rare:

• Leakage of cerebrospinal fluid.
• Vision loss.
• Damage to the pituitary gland.
• Temporary diabetes insipidus.
• Infection of the membranes that line the brain and spinal cord (meningitis).
• Long-term sinus stuffiness (chronic congestion).
• Nasal deformity.
• Nasal bleeding.
• Stroke.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 4 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• You may have blood tests.
• You may have imaging tests, such as CT scan or MRI.
• Plan to have someone take you home from the hospital or clinic.
• Before your procedure, do not use any products that contain nicotine or tobacco for as long as possible. This includes cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to make you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Your face and nostrils will be cleaned with an antiseptic solution.
• The surgery is usually performed through your nostrils and your sphenoid sinus. In some cases, an incision may be made under your lip or near your nose to help perform the surgery.
• Tubes that have small surgical instruments attached will be placed through your nostrils or through your incision.
• A hole will be made in the skull bone at the back of your nose.
• The surgical instruments will be moved to your pituitary gland and the tumor will be removed.
• The area will be examined for other abnormalities or other tumor growth.
• Fat tissue may be taken from your abdomen and used to fill the empty space left by the removed tumor.
• Your skull bone will be closed using a patch of substitute material.
• Soft splints will be placed in your nostrils to keep them open and allow for drainage after surgery.
• If an incision was made, a bandage (dressing) may be placed over it.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will have pain and swelling of the nose. You will be given medicine as needed.
• You will have fluid and blood draining from your nostrils. Your soft splints will be changed as needed.
• You will be given medicine to prevent vomiting if you feel that you have an upset stomach or have to vomit (nausea).
• You may continue to receive fluids and medicines through an IV.
• You will have blood tests to monitor your hormones.
• You may have a stuffy nose (nasal congestion).

Summary

• A transsphenoidal pituitary tumor resection is the surgical removal of a tumor located on the pituitary gland.
• During a transsphenoidal pituitary tumor resection, the tumor is accessed and removed through the nose and the hollow area behind the nose (sphenoid sinus).
• After the procedure, you will have soft splints in your nostril and you may have a stuffy nose (nasal congestion).
• You will be given medicine to relieve the pain and swelling of your nose.

Transsphenoidal Pituitary Tumor Resection, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain and swelling of the nose.
• Fluid and blood draining from the nostrils.
• A stuffy nose (nasal congestion).

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Use nasal sprays as directed to promote healing and clearing of the nasal cavity.

Activity

• Do not drive for 2 weeks, or for as long as directed by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Rest and limit activities or movements as directed by your health care provider. You may take short walks if your health care provider approves. Increase your activity gradually during recovery.
• Avoid these activities for 4 weeks, or for as long as directed:
  • Bending over.
  • Lifting anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you.
  • Straining on the toilet.
  • Blowing your nose.
  • Coughing and sneezing. If unable to stop the sneezing, sneeze with your mouth open.
  • Drinking with a straw.
• Keep your head elevated when you are lying down.

General instructions

• If an incision was made under your lip or near your nose, care for it as told by your health care provider. Keep your bandage clean and dry. Change it as directed.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Do not take baths, shower, swim, or use a hot tub until your health care provider approves. You may be allowed to take showers starting one day after your surgery.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have constant nasal drainage.
• You have a constant feeling of mucus or liquid at the back of your throat (postnasal drip).
• You feel like you need to swallow constantly.
• You have nosebleeds.
• You have difficulty breathing freely.
• You have a fever or chills.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You feel extremely thirsty.
• You lose a lot of weight.
• You are urinating more frequently than usual.

Get help right away if:

• You have a headache that is getting worse.
• You have severe neck pain.
• You feel confused.

Summary

• After the procedure, it is common to have a stuffy, painful, and swollen nose. You may also have blood and fluid draining from your nostrils.
• Use nasal sprays as directed to promote healing and clearing of the nasal cavity.
• If an incision was made under your lip or near your nose, care for it as told by your health care provider. Keep your bandage clean and dry. Change it as directed.
• Avoid bending, lifting, straining, blowing your nose, and drinking with a straw. If you cannot stop a sneeze, sneeze with your mouth open.