What Is Minimally Invasive Neuroendoscopy?
Similar to Minimally Invasive Endonasal Endoscopic surgery, Neuroendoscopy uses endoscopes to remove brain tumors.
Your surgeon may make small, penny-sized holes in the skull to access parts of your brain during this surgery.
You will lie on your back on the operative table. An intravenous (IV) line will be placed in your arm and general anesthesia will be given. The nasal cavity is prepped with antibiotic and antiseptic solution.
An image-guidance system may be placed on your head. This device helps the surgeon navigate through the nose using a 3D “map” created from your CT or MRI scans.
In a minimally invasive endoscopic procedure, the ENT surgeon inserts the endoscope in one nostril and advances it to the back of the nasal cavity. An endoscope is a thin, tube-like instrument with a light and a camera. Video from the camera is viewed on a monitor. 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
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.
Through a small hole in the Sella, the tumor is removed by the neurosurgeon in pieces with special instruments called Curettes
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.
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.
The hole in the Sella floor is replaced with bone graft from the septum. 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 are 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.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation we require detailed medical information in the form of a medical questionnaire. Although not all the tests may be required for each patient, they usually include:
All of this information will allow the doctors that we work with to determine your eligibility for the procedure. Your surgeon will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery.
Stop taking all non-steroidal anti-inflammatory medicines (and blood thinners 1 week before surgery. Additionally, stop smoking and chewing tobacco 1 week before and 2 weeks after surgery, as these activities can cause bleeding problems
Also bring a complete list of your current medications (including over-the-counter drugs, vitamins and herbal supplements), allergies, your medical records and any health insurance information.
If you develop a cold, fever or sore throat within a few days of your surgery, or have other questions or concerns, contact our offices immediately.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Upon arriving in Cyprus, as part of the pre-surgery tests done at our partner hospitals you will again receive chest X-rays, blood tests, an electrocardiogram and any other tests shall be performed. Your surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Wash your hair with antiseptic soap for 3 consecutive days prior to surgery.
Getting ready your house before surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day before surgery
Your surgical nurse will provide you with these instructions the night before surgery:
Morning of surgery
On the day of your surgery, your designated Salus Patient Concierge along with a nurse may talk with you and your loved ones. They shall tell you what to expect. You will most likely feel a little nervous before surgery, so the Salus team and the hospital staff will do all they can to answer your questions and help you relax.
Make sure all your medicines in their original containers with you to the hospital.Some medications will need to be continued or stopped the day of surgery. Bring a list of allergies to medication or foods.
You will be scheduled for presurgical tests (e.g., a blood test, electrocardiogram, chest X-ray, and CT scan) several days before surgery.
You will meet with the anesthesiologist who will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery.
You should leave jewelry, watches, money and other valuables with the person who accompanies you or with our staff member who will place them in our safe.
Proceed with your routine morning care:
You will have an IV or intravenous line put in to give you fluid and medicine during your surgery.
When it is time for you to go to surgery, your family/ companion will be asked to wait in the waiting area. Your doctor will talk to your family/ companion there after your surgery is done.
RECOVERY AFTER SURGERY
Once awake, you will be moved to a regular room where you’ll increase your activity level (sitting in a chair, walking). You may spend a night in the intensive care unit (ICU) for closer monitoring.
You may experience nasal congestion, nausea, unsteadiness, and headache after surgery. Medication can control these symptoms. An endocrinologist may see you the day after surgery to check that the pituitary gland is producing appropriate levels of hormones. If it is not, hormone-replacement medications may be given. An MRI of the brain will be obtained the day after surgery.
Patients usually stay in our partner hospitals for 1-2 days or longer if necessary, after surgery. During this time, some tests will be done to assess and monitor the patient’s condition.
Hospital dischare and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
You will remain hospitalized for about 1-2 dayswhile your heart is monitored and your vital signs are checked frequently.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your
care after you leave the hospital.
To relieve nasal congestion, prevent bleeding, and promote nasal healing, you will be given two sprays for the nose: a nasal decongestant and a salt water spray.
If you had an abdominal incision to obtain a fat graft, it should be left open to the air with no bandage. Avoid direct water on the incision and apply Vitamin E liquid daily.
Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of a major operation.
After release from the hospital, the patient may experience side effects such as:
Many of these side effects usually disappear in one or two weeks, but a full recovery may take a few months or more.
Doctors also often recommend following a home routine of increasing activity- doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.
Most people with sedentary office jobs can return to work in four to six weeks. Those with physically demanding jobs will have to wait longer. In some cases they may have to find other employment.
Lifting and Reaching
Do not lift, push or pull objects heavier than 5 pounds until your doctor says it is okay to do so.
You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.
To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.
Climbing Stairs and Steps
Unless restricted by your doctor, it's okay for you to climb stairs and steps. Because you may be off-balanced after surgery, be careful and hold the handrail when walking up and down stairs. If you need to, stop and rest before you finish walking up or down a full flight. Try not to use the stairs immediately after surgery, and try to plan your activities so that you use the stairs only when necessary.
Fatigue is probably the number one patient complaint following surgery. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.
Driving and Riding in a Car
You should not drive for 3-4 weeks from the date of your surgery or while you are still taking narcotic pain pills. During this time your reaction time may be dulled, and if an incision was made on your sternum, your breastbone will still be healing. You may be a passenger in a car at any time. Make sure to wear your seat belt. You may cushion your incision with a soft towel or pillow.
Returning to Work
Returning to work depends upon the type of work you do and your energy level. It usually takes 4-6 weeks before most patients feel they have returned to their full energy level. The decision to return to work should be made jointly between you and your surgeon. You may want to consider working half days at first.
Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.
Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.
Tips for exercising:
Make sure you are not exercising too hard. Stop if you are exhausted, short of breath or feel dizzy. Call your doctor if these symptoms persist and you are not able to do your regular exercises.
Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Call you surgeon right away if you have:
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.Your surgeon will plan your post operative and routine follow up appointments with you and your local physician.
You will have a follow-up visit with your surgeon 1 week after surgery to remove the nasal splints and to check the surgical site.
Upon your return home, you will have post operative appointments with your local physician who will see you every 3 weeks thereafter until the nasal cavities are healed. Typically, this requires 2 to 4 visits.
Small crusts often form in the nose that can cause nasal congestion. The physician will spray the nose to provide local anesthesia to the nasal cavities. Crusts can then be removed comfortably. Four weeks after surgery, the patient will be instructed to use a nasal saline rinse. The rinse will decrease the need to remove crusts and hasten nasal healing.
An appointment for a follow-up visit with your neurosurgeon will be scheduled for 2 to 4 weeks after surgery. An endocrine follow-up may be recommended to determine if hormone replacement medications are needed.
In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.
Any time before your appointments, you should call your doctor if you: