martes, 5 de febrero de 2019

Recovery from Endoscopic Endonasal Surgery

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By Tim Boughton, M.Sc.Reviewed by Jennifer Logan, MD, MPH

Endoscopic endonasal brain surgery is a minimally invasive technique that is associated with reduced recovery times compared with traditional techniques such as craniotomy. The total amount of time required to recover following this procedure will vary by;

tumor location
areas of the brain affected by surgery
age and general health of the patient
whether the patient encounters any complications or requires further treatment

Waking up after the operation

Following endoscopic endonasal surgery, patients spend on average of 2 to 5 days in the hospital. Immediately following surgery, you will be taken to the recovery room, where you will wake up as the anaesthetia wears off. You may experience nasal congestion, nausea, headaches, and pain after surgery. However, these symptoms will be managed by medication. If your vital signs (heart rate, breathing rate, blood pressure, and temperature) require closer monitoring, you may spend a night in the intensive care unit (ICU). Your family members will be able to visit once you are in a stable condition and the medical professionals have completed their initial post-surgical assessment.

What happens immediately after surgery?

Once you have been moved to a regular hospital room, the nurses will encourage you to increase your activity level. You will begin this recovery by sitting up in a chair then progressing to standing and walking. You will be given something to drink, and, if you tolerate this well, you will soon be able to eat as well.

What is the recovery from endonasal endoscopy?

Following endoscopic endonasal surgery, a nasal dressing and nasal packs are applied to your nose. These help contain any drainage of fluids from the nose and back of the throat. They will be removed the day after surgery. To prevent injury to the surgical site, it is advised that you refrain from activities that could increase pressure of spinal fluid inside the head (such as blowing your nose, bending over, lifting, or straining) for up to a month. Many patients report a decrease in smell and taste for several months following surgery, due to decreased air flow through the nasal passage.

What post-operative assessments will be performed?

During your hospital stay, you will be closely monitored by a team of medical professionals. A range of assessments and tests may be undertaken during this time related to the specific site of your brain surgery. For instance, if the tumor was located near your pituitary gland, the nurses will assess for changes in your vision, fluid intake, and urine production (signs for diabetes insipidus), and any nasal discharge. An endocrinologist may also visit to check your hormone levels. You may be prescribed hormone-replacement medications if your pituitary gland function has been affected. Further imaging scans, such as magnetic resonance imaging (MRI) and computerized tomography (CT) scans will be performed during the first few days after surgery. These assessments help to determine the success of the surgery, the rate of resection, and to establish a post-operative baseline for future comparisons.

Rehabilitation

Surgical procedures on the brain can affect a person’s thoughts, feelings, and behaviours. Extra support may be needed to help you overcome any problems you have. This may include therapies such as

Physical therapy to help you walk and move safely before your release from hospital.
Occupational therapy to help identify any problems you may have with daily activities, and to make any necessary adjustments to your home. They will also help to assess your ability to return to work and drive a vehicle safely.
Speech and language therapy to help evaluate and overcome any difficulties with communication, speech, or swallowing.

What happens after hospital discharge?

Your medical team will brief you and your family about home care and what to expect during the healing process. They will also give you details of any follow up appointments with your medical team.

You will be advised to avoid heavy lifting (anything heavier than 10 to 15 pounds) for a month. It is also advised that you avoid any activities where your arms are above your shoulders for a long time. Doctors often recommend a home routine of increasing activity as your fatigue and pain subside over the first few weeks.

Driving

You may not be allowed to drive for awhile after undergoing brain surgery. It is best to wait until after your follow-up medical evaluation before you start to drive again.

When can I return to work?

The length of time it takes for you to return to work will vary significantly depending on how physical your job role is. Fatigue is a common symptom after brain surgery, which often restricts your return to work. It is advised that you create a staggered return to work plan with your employers, at first returning on a part-time basis, before returning to full-time employment when you feel comfortable.