Most pituitary surgery is done through the sphenoid sinus, which is an air cave lying immediately below the pituitary gland. There are many different ways to access problems in this area. The favoured approach by Dr Little is the endonasal transphenoidal. This requires putting a small speculum up one nostril to the back of the nose (front of the sphenoid). The “cave” is then opened into allowing access to the bottom part of the pituitary. Using microsurgical dissection and often endoscopic assistance the problem (usually tumour )is removed. Sometimes the approach has to be from under the top lip behind the nose. This surgery is done in collaboration with an ear nose and throat surgeon.
At the end of the surgery a graft of muscle or fat may be required to repair the base of the skull. If required this is taken from the side of the thigh.
All surgical procedures are associated with risk. To exhaustively list all the potential complications is impossible. In general the overall risk of a major adverse event from pituitary surgery is low, but significant. There are general and specific risks.
This is the risk faced by most people undergoing a general anaesthetic. It includes, but is not limited to, blood clots in the legs (and lung embolism), allergy to drugs, heart attack, lung infection or collapse. These are all rare but may be very serious if they occur.
These include , but are not limited to, injury to surrounding structures (optic nerves, carotid arteries, brain), access injuries (nasal perforation, sinus inflammation, gum/tooth numbness, nasal deformity), pituitary insufficiency (hormone lack).
IMMEDIATELY AFTER SURGERY
Most patients will be nursed in an intensive care or high dependency environment for at least the first twelve hours after surgery. If a repair is required then a spinal drain will be used to divert spinal fluid (This is a small tube in the back inserted at the time of surgery ), and the intensive care stay will be longer.
There are packs placed at the end of surgery into the nose which may stay for between 12 and 72 hours.
Often an endocrinologist will be involved in your inpatient care and they will be responsible for any prescription or alteration of hormonal therapy.
A condition called diabetes insipidus is something which may occur temporarily in up to 10% of patients. This causes excess urine production and is usually temporary. It can be readily treated with a nasal spray.