My Surgery: Transsphenoidal Surgery Guide

You must come for your pre-admission appointment before your surgery. If you don't come for your pre-admission visit, your surgery will be cancelled (unless you were given other instructions).

In the weeks before your operation, you will have a pre-admission appointment. This appointment could take 2 to 4 hours, or sometimes longer.

• You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
• You may also need an electrocardiogram (ECG) to check your heart and a chest x-ray to check your lungs.
• You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have.
• A pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for cleaning your skin, eating before your operation, taking your medications and pain management.
• A pharmacist will review your medications.
  
• At this appointment you may also see an anesthesiologist and an endocrinologist.

Don’t eat or drink anything after midnight on the day of your surgery. Your surgery will be cancelled if you do. You may be able to take some medicines the morning of your surgery. The pharmacist or nurse will talk with you about this at your pre-admission appointment.

• Do not eat or drink after midnight on the night before your operation.
• If you smoke, do not do so for 24 hours before your operation.
• Do not drink alcohol for 24 hours before your operation.
• Remove all nail polish and body piercings.
• You must have a shower with soap and water to clean your skin the night before and the morning of your operation to reduce the chance of infection after your operation.

• You will get an Intravenous (IV) that will allow the doctors to give you fluids and medicine through your vein during and after the surgery.
• A doctor will give you a general anesthesia. This means that you will be asleep during the surgery.
• You will probably have a catheter (tube) inserted into your bladder. This will allow the doctors to carefully monitor your fluids and urine output.
• Once you are asleep, your surgeon will insert the small tube (endoscope) into your nose through your sphenoid sinus to your pituitary gland. This will help them see a wider area around your gland.
• Your surgeon will have to remove a small piece of thin bone at the base of your skull to reach the pituitary gland. They will then make a small incision (cut) to get to the tumour or cyst.
• Using special instruments, your surgeon will try to remove the tumour or cyst without disturbing the normal pituitary gland.

The surgery usually takes about 2 to 4 hours.

On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.

• What will happen right after my operation?
• How will I feel after my operation?
• How can I take care of myself after my operation?
• How long will I stay in the hospital?

• You will wake up in the operating room after the surgery and be taken to the PACU (post anesthetic recovery room). No visitors are allowed at this time.
• You will usually stay for 1 to 2 hours while the nurses monitor you.
• When you are stable, you will be taken to the Nursing Unit within the ICU or on 6a. Visitors are allowed to visit you there.
• Your fluid balance (what you drink and urine output) will be closely monitored through your catheter. This tube will be removed 1 to 2 days after your surgery.
• Your nurse will continue to check how much you are drinking and urinating. They may ask you to keep a record of this.

• Your nose may feel congested (stuffy) after surgery and you may find it difficult to breathe through your nose at first. You may find it easier to breathe through your mouth.
• You may have gauze covering your nose for any drainage (fluid leaking) that can happen immediately after surgery

Try to avoid blowing your nose, sneezing, or coughing a lot or hard for 1 to 2 weeks. This will help the inside of your nose heal. It may also reduce your risk of nose bleeds.

Usually, you will be ready to go home about 2 to 3 days after your surgery. The hospital discharge time is before 11:00 am. You need to have a family member or friend take you home.

Before you leave:

• You will get a discharge package that includes an information sheet, follow-up appointments, and a prescription for medicine, if needed.
• If you had nasal splints put in (ask about this before you leave), you will have an appointment to have them removed. You should have an appointment time scheduled before you leave the hospital.
• If your discharge is on the weekend, we will contact you with an appointment in a few days. If you do not receive an appointment, please contact you doctor’s office.

 

Go to nearest Emergency Department if:

• Your temperature rises above 38.5 °C or 101 °F and you feel chills.
• You have a severe headache that does not go away.
• Daylight causes intolerable pain in your eyes.
• Your neck becomes very stiff and sore, making it painful to bend your head forward.
• You are less alert.
• You have a nose bleed that will not stop.
• The amount of fluid from your nose doesn’t decrease after 1 week. This may be caused by a CSF leak.
• You are losing too much fluid from your body:
  • You are urinating (peeing) more than usual.
  • You are getting up 3 to 4 times at night to urinate (pee).
  • You often feel very thirsty.
• You feel very tired and have very low energy.
  

Please call your neurosurgeon or Physician Assistant/Nurse Practitioner to let us know that you have had these symptoms and have gone to the emergency department.

It usually takes about 2 to 6 weeks to recover from the surgery, but it can take up to 3 months for some people to feel like their normal self again. Everyone’s recovery time will be different.

If you use a CPAP machine for sleep apnea, please discuss this with your team. You may be asked to wait 2 weeks after the surgery before re-using your machine. Make sure your machine is clean before you start using it again.

It is important to keep your nose clean and moist while you heal. Use only a normal saline nasal spray to moisten inside your nostrils. Don’t put any creams, ointments or objects into your nose. You can buy saline nasal spray (like Salinex or Simply Saline) at your local drug store.

To clean your nostrils:

• Spray each nostril with the saline spray at least 5 times a day or more. Do this for at least 3 to 4 weeks. Using saline spray keeps hard crusts from forming in your nose. These hard crusts can slow your healing and block your breathing. Using saline spray will also reduce bad odours from your nose which sometimes can happen after this type of surgery.
• If you have on-going bad odours from your nose and a lot of congestion (stuffy nose) one month after surgery, continue to use your nasal spray and talk with your ENT or your neurosurgeon. Your smell may be affected for the first few weeks after surgery. This is normal and will be temporary.

 

Eating/eliminating

• Once you get home, you can eat and drink normally. Avoid alcohol for 2 days after your surgery.

 

Lifestyle

• You should be able to slowly return to your normal activities once you get home. Going for walks and doing light activities around the house is fine.

Showering

• You can shower, bathe and wash your hair as usual.

Heavy objects/lifting/exerting

For the first 6 weeks:

• Try not to lift anything heavier than 10 pounds (5 kilograms).
  
• Try not to bend forward or strain yourself.

Exercise

• Don’t go to the gym or do your regular exercises.
• Don’t play contact sports (soccer, football, hockey).
• Don’t swim or submerge your face in water. Talk to your doctor about when you can go swimming at your follow-up appointment.

Work

• Most patients are ready to return to work in 4 to 8 weeks. As you feel better, slowly return to your normal daily activities..

Driving

• You can travel by car once you feel ready. This may take a couple of days. Having surgery may make you feel more tired than usual, so only drive short distances at first.
• If you had vision problems before surgery, make sure your vision is checked before you drive. Follow up with your optometrist or ophthalmologist.

Traveling by plane

• If you plan to travel by airplane before your first post-operative clinic visit, please discuss this with your neurosurgeon first.

Go to nearest Emergency Department if:

• Your temperature rises above 38.5 °C or 101 °F and you feel chills.
• You have a severe headache that does not go away.
• Daylight causes intolerable pain in your eyes.
• Your neck becomes very stiff and sore, making it painful to bend your head forward.
• You are less alert.
• You have a nose bleed that will not stop.
• The amount of fluid from your nose doesn’t decrease after 1 week. This may be caused by a CSF leak.
• You are losing too much fluid from your body:
  • You are urinating (peeing) more than usual.
  • You are getting up 3 to 4 times at night to urinate (pee).
    
  • You often feel very thirsty.
• You feel very tired and have very low energy.

Please call your neurosurgeon or Physician Assistant/Nurse Practitioner to let us know that you have had these symptoms and have gone to the emergency department.

If you have any questions, please call the Pituitary Clinic at 416 603 5463.