Sometimes the regulation of sex hormone production oestrogen in women and testosterone in men is affected by pituitary surgery and levels may be low. This will be checked and hormone replacement therapy advised if necessary. You can drink alcohol after your operation, but we recommend no more than one or two units per day one unit is a small glass of wine, a single measure of spirits or half a pint of beer.
After surgery, your surgeon may recommend nasal douching to help clear any nasal crusting and debris if appropriate. Patients have reported they feel their nasal passages open up quicker and sometimes a more rapid recovery in the sense of smell. If recommended, this would initially be four times a day and as your nose clears up you may reduce the frequency to twice a day. We recommend at least weeks of douching. Alternatively you can make up a solution at home please ask your key worker for a leaflet.
One of the benefits of endoscopic surgery is that stitches are usually not required in or around the nose. In some cases, a repair is required and performed with fat and or facia from the thigh or stomach, you will have stitches or skin clips placed in these areas and these can be removed after days by a nurse at your local GP practice.
You will be reviewed in the Combined Pituitary Clinic at Hurstwood Park 6 to 8 weeks after your operation, where you will see the neurosurgeon, an endocrinologist and an endocrine nurse specialist. You will have a repeat pituitary MRI scan 3 months after your operation, and you may also have assessments of your vision visual field tests. Most pituitary patients require life-long follow-up to continue to check on their hormone status, scan appearances and vision. With time, these appointments and tests become much less frequent.
Royal Sussex County Hospital Endocrine specialist nurse extension If you have any urgent or emergency questions then your GP can advise you or they will contact the hospital on your behalf. Patient self-help groups and further information: The Pituitary Foundation. Lifting weights : Ask your surgeon for specific limitations on weight lifting, swimming, and any other activity involving great physical exertion.
Typically you are asked to avoid lifting more than 10 lbs or bending past your wait for 12 weeks. To diminish this risk try to: Avoid direct firm pressure on the face for at least 4 weeks. Nose blowing, or sneezing with mouth closed should be avoided for at least 12 weeks after surgery. Try to sneeze with your mouth open for 12 weeks to avoid generating high pressure in your head.
Smoking : Smoking delays healing and can cause a wound infection. Reducing this activity or stopping completely will improve your chance of a speedy recovery. Driving : Is not recommended until you have: Stopped taking narcotic pain medications Experienced no visual problems that affect your ability to drive Complete awareness of your surroundings Total control over your fine motor movement and regained your strength Sleeping : Sleeping with your head elevated on pillows may help decrease headaches.
Keep it elevated at least 30 degrees for 10 days after surgery if you were told there was a cerebro-spinal fluid CSF leak after surgery. Use a humidifier at night to keep your nasal membranes moist if needed. Bathing : Showering is appropriate upon approval from the surgical team. Do not immerse bath, pool, hot tub, etc.
Pituitary Tumor Recovery Diet Frequent small meals 4—6 per day are suggested with a moderate amount of protein in each to assist in the healing process. Pituitary Tumor Recovery Medication Prescriptions for pain control and other medications are provided at discharge.
Discuss the possible interactions between various medications that you are taking with your physicians. Make certain that you take your medications with food, as many cause nausea on an empty stomach. Many pain medications cause constipation, so stool softeners may be beneficial. Ask your surgeon before taking medications that contain anticoagulants blood-thinning properties such as ibuprofen or aspirin.
Your surgeon may prefer that you wait anywhere from 10 days to 4 weeks after surgery before taking blood-thinning medications. Please note that Vicodin and Percocet both contain acetaminophen Tylenol.
Do not take Tylenol while you are taking these medications, because taking more than 4, mg of Tylenol in a hour period can lead to liver damage. Avoid drinking alcohol, driving, and operating heavy machinery while taking prescription narcotic medication for pain.
Stents, nasal packing, and gauze dressing under your nose may be used to absorb nasal drainage and will be removed at the discretion of your surgeon. Keep your abdominal incision clean and dry.
Showers are typically approved by your surgeon within a day or two after surgery. Post-Pituitary Surgery Infection Please keep your fingernails trimmed short to decrease the risk of incision irritation and infection from scratching as healing occurs. You can also raise the head of your bed by putting bricks or wooden blocks under the bed legs.
After lying down, bring your head up slowly. This can prevent headaches or dizziness. You can wash your hair 2 to 3 days after your surgery. But do not soak your head or swim for 2 to 3 weeks. Do not dye or colour your hair for 4 weeks after your surgery. Ask your doctor if it is safe for you to travel by plane. If you had surgery under your lip or through your nose: Do not blow or pick your nose or cough hard for 4 weeks after surgery. Do not use any medicines that you need to inhale through your nose.
If you had surgery under your lip: Do not brush your teeth for up to 2 weeks after your surgery. Your doctor will give you swabs to use instead of a toothbrush. You will also get a special mouthwash to rinse with after eating and drinking. The mouthwash helps your incision heal.
Do not wear dentures for 2 weeks after surgery. You will probably need to take a few weeks off from work. This depends on the type of work you do and how you feel. You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
Follow your doctor's orders about how much fluid you should drink after surgery. Ask your doctor when it is okay to drink alcohol. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines. If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again.
Make sure that you understand exactly what your doctor wants you to do. Take any new medicines exactly as directed. You may need to take hormone medicines. The surgeon passes long instruments through the nostril while watching the monitor. A small portion of the nasal septum dividing the left and right nostril is removed.
Using bone-biting instruments, the front wall of the sphenoid sinus is opened Fig. Step 3: open the sella At the back wall of the sphenoid sinus is the bone overlying the pituitary gland, called the sella. The thin bone of the sella is removed to expose the tough lining of the skull called the dura. The dura is opened to expose the tumor and pituitary gland. Step 4: remove the tumor Through a small hole in the sella, the tumor is removed by the neurosurgeon in pieces with long grasping instruments Fig.
The center of the tumor is cored out, allowing the tumor margins to fall inward so the surgeon can reach it. After all visible tumor is removed, the surgeon advances the endoscope into the sella to look and inspect for hidden tumor.
Some tumors grow sideways into the cavernous sinus, a collection of veins. It may be difficult to completely remove this portion of the tumor without causing injury to the nerves and vessels. Any tumor left behind may be treated later with radiation.
At some hospitals, surgery can be performed in a special OR room equipped with an intraoperative MRI scanner. The patient can undergo an MRI during surgery. This technology enables more complete tumor removal and may reduce the need for a second operation [1]. Step 5: obtain fat graft optional After tumor is removed, the surgeon prepares to close the sella opening.
If needed, a small 2cm skin incision is made in the abdomen to obtain a small piece of fat. The fat graft is used to fill the empty space left by the tumor removal. The abdominal incision is closed with sutures. Step 6: close the sella opening The hole in the sella floor is replaced with bone graft from the septum Fig.
Synthetic graft material is sometimes used when there is no suitable piece of septum or the patient has had previous surgery. Biologic glue is applied over the graft in the sphenoid sinus. This glue allows healing and prevents leaking of cerebrospinal fluid CSF from the brain into the sinus and nasal cavity. Soft, flexible splints may be placed in the nose along the septum to control bleeding and prevent swelling. The splints also prevent adhesions from forming that may lead to chronic nasal congestion.
After surgery you will be taken to the recovery room, where vital signs are monitored as you awake from anesthesia. Then you'll be transferred to a regular room or the intensive care unit ICU for observation and monitoring.
You will be encouraged to get out of bed as soon as you are able sitting in a chair, walking.
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