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PATIENT GUIDE TO MINIMALLY INVASIVE, MICROSCOPIC TSSH

This is a guide to the pituitary operation I have recommended to you. The medical name is a TSSH that stands for TranSSphenoidal Hypophysectomy. The sphenoid is a part of the skull just in front of the pituitary gland. "Trans-sphenoidal" means that the approach to the pituitary gland involves going through this area. The medical name for the pituitary gland is the hypophysis. As you may know, "-ectomy" means to remove. Therefore the operation means that the surgeon goes through the sphenoid sinus to remove the abnormal part of the pituitary gland.

PREPARATION FOR SURGERY:   There is no special preparation for this operation. You should have nothing to eat or drink after midnight before the day of the surgery. If you take medications in the morning, please take them as you normally would with a sip of water. There is no special skin cleansing or preparation.

When you come into the hospital, you will be directed to a part of the Operating Room called the "holding area". There you will have an intravenous placed and talk with the anesthesiology doctor. A light sedative will probably be given, and you will wait as the surgery suite is prepared for your microsurgery.

THE SURGICAL PROCEDURE:   After you enter into the Operating Room, you will be given another intravenous and will drift off to sleep. You will feel and remember nothing of the operation that generally takes 2 hours. If the operation starts around 8:00 in the morning, your friends and family can expect to hear from me before noon.

After you are asleep, an approximately 1-inch incision is made under your upper lip. When this heals, it will not be visible. The operation involves going underneath the nose, and then through the sphenoid sinus (a natural, air-filled part of the skull) with the use of the operating microscope. I then arrive at the pituitary gland that is covered by a leathery membrane called the dura. An incision is made in this membrane giving exposure to the front of the pituitary gland.

The tumor can usually be seen easily, though the actual size of the normal pituitary gland is about that of a marble. The tumor within can be as small as a BB or as large as a nickel. With microscopic guidance, the tumor is gently and carefully removed. It is usually very soft and similar to oatmeal in consistency. On occasion in the past, I have placed a small TV camera in that area (an endoscope) to assist in as complete a removal of the tumor as possible.

Once a hopefully complete removal has been obtained, the procedure is finished. From the time I can see the front of the pituitary gland to the time I am finished removing the tumor is about 15 minutes. The microscope is removed, and then the small incision beneath your upper lip is stitched up. These stitches will melt on their own, and do not need to be removed. The membrane is then closed as carefully as possible.

As mentioned above, we have gone underneath the nose to do this procedure. Some gauze packing is placed in the nostrils overnight to allow them to heal normally. These are annoying while they are in, as you may be unable to breathe through your nose during that time.

AFTER THE SURGERY: The hospital stay after this operation is about 2 days. When you wake up, you may notice that you cannot breathe through your nose for the reasons mentioned above. There is often swelling in the middle of your face and sometimes bruising that can track down along the sides of the mouth towards the chin. This bruising will go away very quickly and is generally gone within one week from the time of the surgery.

When you get home, you will have various aches and pains from the surgery itself. The middle of your face may be swollen and bruised. You will generally be surprised how quickly this resolves. You may notice some numbness in the upper lip and the front, upper teeth. This is annoying, but generally goes away over several months. For those of you that wear dentures, this is bothersome.

Most people return to work about two weeks after this procedure. During these two weeks, you may drive and partake in any of your usual activities apart from competitive sports. Although it is difficult, I encourage you not to blow your nose, or pick at your nose. After two weeks it is essentially healed and there are no restrictions on what you may do. You should note that sometimes for several weeks after the surgery, small or large bits of clotted blood or mucous will come from your nose or go down the back of your throat. This is normal and it may be a full month before it stops occurring.

BENEFITS AND RISKS: The benefit of the surgery is to cure your tumor. In general, the chance of a cure is about 90%. If your tumor is secreting a hormone, this and the problems it created will generally resolve over a year. There is the chance that the tumor could come back some day; sometimes this requires treatment and sometimes it does not. One approach that has become increasingly useful in recent years is a one-day radiation treatment called Gamma Knife Radiosurgery.

If your symptom was loss of vision, in general this will come back very quickly in a matter of a few days or weeks. Many people comment on the increased sharpness of their vision and the increased vividness of colors. Peripheral vision is also often greatly improved.

The risks of the surgery are loss of vision, stroke, infection, and death. These occur less than 1% of patients. In the over 25 years I have performed this procedure, I have caused near-blindness in one man who developed internal bleeding after a TSSH I performed on him. I caused one stroke in another man whose left arm and leg became paralyzed after surgery. He made only a partial recovery. Infections are rare, and are generally easily treated with antibiotics. I have caused less than 5. Two patients have died after I performed this procedure on them; one woman passed away at home of what was likely a heart attack. Another died in the hospital of a pulmonary embolism.

If your hospital course is uneventful after the procedure, you may be seeing either me or care providers whom I work with. You and your family are always free to contact me in my office or through my answering service.


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Stephen Saris, M.D.

December 29, 2007

Neurosurgery Associates, Inc.
1 Davol Square,
Suite 302
Providence, Rhode Island 02903


(401) 453-3545

FAX (401) 453-3533

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Neurosurgery Associates
Neurosurgery Associates