Miss Diagnosis: Another Sinus Infection

Wednesday, April 1, 2009

Another Sinus Infection

Prior to pituitary surgery Alex never had a sinus infection; things change once they mess around inside there. This past year she has had several, the latest one this week. Over the weekend she was complaining of a headache, eye pain, sinus pain and had a low grade fever off and on. Sunday night she had her first ever gushing nose bleed. Weird, because earlier in the evening she said it felt like something popped in there. The problems are always on the left side; it's the one they went in through for surgery.We saw the pediatrician on Monday and got Alex started on Augmentin yesterday. Hopefully 10 days of antibiotics will get rid of it this time.

It's going to be a week of appointments. Next up is the G.I. doc on Thursday, followed by the surgeon at Stanford on Friday. Next Monday she has a dental appointment. It should be fun just getting her up and out of the house that many days in a one week time frame. As of yesterday she seems to be cycling up, so that should help, if it lasts.

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Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.