Pituitary Innovation and Teaching

Overview of the surgery process

Video transcript

Speaker: Dr. Michael Cusimano

After you get into the operating room a checklist will be run over with you with the staff to make sure everyone’ s on the same page. And so in this check list we’ll be going through again the consents, making sure your consent is there, making sure your X-ray films, that is your MRI and CAT scan is available, that your blood work is there. We will be probably putting on some devices on your legs which are like stockings that massage your legs and to allow the circulation of blood to continue during the operation.

And then the anesthesia will go over their various checklist items. For example, they’ll go over the equipment and tell their team that the equipment is ready and the nurse will go through their checklist items to say that all the equipment that we need to do the surgery is ready. Once that’s done, then the anesthesia doctor will start to put you off to sleep.

It’s usually a matter of 10 to 15 minutes before you’re off to sleep and then the work continue s and we will set up various navigation aids that we use, the GPS system while you sleep. When you’re off to sleep and we’re sure that the anesthetic is deep enough, your head will be placed in a clamp that holds your head very still while we do the surgery. Some patients do feel a bit of tenderness in four points where the four points of the clamp hold their head still and this allows us to do the surgery without the head moving during the operation.

The operation itself will last a variable amount of time, obviously depending on the particular patient’s tumor and circumstances, but it generally takes about an hour after you get off to sleep to before we start the actual operation. The ear, nose, and throat – our ENT doctor will do their part of the operation first – that generally lasts about another hour and then the neurosurgeon will take over and do the part of the surgery around the brain and that can take anywhere from 1 to 6 or 7 hours depending on the type of tumor and the type of work that needs to be done.

And then the area will be repaired - it will take about half an hour to get you awake again and then the patient will generally go to the recovery room or the post anesthetic care unit, which is on the same floor. And then the surgeons will go and meet with your family and friends or whoever has accompanied you or telephone them if they weren’t able to stay or they are not able to make it that day and let them know how things are going. From there you’ll be generally brought up to the ninth floor after an hour or two of the observation and you’ll stay on the ninth floor for that night and for two or three days afterwards.

When the person awakes from surgery, initially they’ll be a bit groggy from the anesthetic but once they regain full conscious they’ll realize that there is usually some packing in their nose and that packing will come out within hours or the next day generally. Um, and what is left in the nose is a plastic sheet on each side of the mid line of the nose and this is to prevent scar tissue. And those two plastic sheets are stitched in place and they’re kept in place for few weeks until the patient has a chance to see the ear, nose and throat specialist. At that first visit with the ear, nose and throat specialist, those sheets will be removed and the nose will be inspected for any scar tissue and generally the breathing gets much easier after those are removed.

The issues to look for once a patient goes home would be leakage of clear, watery fluid dripping out of the nose. It would look like faucet that’s dripping. If that were to occur, the person should collect some of that fluid in a clean container - like a bottle - and bring it to the hospital and notify the doctors right away. It will be tested for a chemical called Beta Two Transferin, which is a chemical that is only found in the cerebral spinal fluid or the brain water to determine if it’s actually a leakage from the brain or not. If there’s any gushes of bleeding or any worrisome bleeding, patient should come to the hospital. If there is excessive bad odor coming from the nose, person should come back. If the person is noticing any problems with their vision, where initially it got better and now it’s getting worse, they should certainly come to the hospital.

Worsening headaches or persisting headaches would be a sign to come to the hospital or notify the physician. And of course, any problem where there’s a general lack of energy, the person develops severe dizziness or vomiting - can’t keep any food down which might suggest a lack of a hormone, the person should come. Or that the person is excessively thirty and constantly drinking water, constantly passing their water, getting up at night, 3, 4, 5, 6 times a night to pass their water and constantly needing to drink. These are a signs of a lack of hormones that are going on and can easily be treated by replacing those hormones that are responsible for that.

 

Page last updated: June 3, 2016