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Nasal discharge (CSF?) post transphenoidal surgery for pituitary tumor?...
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Nasal discharge (CSF?) post transphenoidal surgery for pituitary tumor?

Hi, I had endoscopic transphenoidal surgery performed to remove a pituitary macro-adenoma on 11/29/10. The surgeons (ENT and Neuro) say the surgery went very well and they did not see or suspect a CSF leak. I had a LOT of bloody discharge after the surgery for close to two weeks, which the surgeons assured me was normal. Headaches went away a week after surgery but resumed, along with nose pain, after I started to sneeze about two weeks after surgery. I'm now almost three weeks out and sneeze (cannot stop it, no matter how much I try) 2-3 times a day. This causes pain in my nose, a slight headache, which tylenol relieves, and I continue to have nasal discharge but now it's not bloody, it's clear. There's no post nasal drip, no salty or metallic aftertaste, the headaches are much better and infrequent, I feel fine standing up and lying down, and the discharge is not constant but has me worried. I saw my ENT a week after surgery and he wasn't concerned. I will see him in three days again (three weeks post surgery). I think I just caught a cold - hence the sneezing, but I wanted to get others' thoughts as well. What do you think?

For those of you who had surgery through the nose, waht was your recovery like?

Thank you!
Lana
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657231_tn?1390151580
Ah... every one has to sneeze - but to take the "pressure off", open your mouth so it diffuses what comes out your nose and then it will not hurt your surgical site so much. It can be a bit more messy (keep tissues around) but it will hurt your head less!

I had a problem with drip and it lasted a bit long - and we have a person here with a CSF leak. I developed an infection post-op and if you had that, you will know it by the smell which you cannot escape. Not having a huge headache is a good sign that it is not a leak.

Did you have any scabs come out? That sometimes come out - they can be large, fall out and go down the throat if you don't spit them out.

Does coffee help?
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Avatar_f_tn
Hi, I did have many scabs but they are less frequent. You mentioned you had a drip for a while. What was it like? Clear? From both or one nostrils? Did you have the salty taste in the back of your mouth? The residents at the hospital made me completely paranoid about having a CSF leak while both my surgeons said I was perfectly fine.

I definitely don't have a headache but do have a little bit of a smell, but I've had that from the very beginning.

I haven't tried coffee. I feel like I just have a runny nose from a cold (hence the sneezing) but don't know how to tell for sure and am getting very panicky.
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657231_tn?1390151580
Mine was clear. I could not tell where it was coming from I had to wear gauze on my nose to prevent it from just dripping down my face... not fun. Ah the memories....

If you know someone with a glucometer - you can test the fluid - snot has no glucose, CSF does. Plus CSF does make different patterns on a coffee filter - rings - while mucus does not.

Caffeine is an old treatment for the leaks - as well as lying flat.
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Avatar_f_tn
Wow! That sounds like a lot of fluid! So glad it wasn't CSF. How did they explain it?

I don't know anyone who has a glucometer but will try to get in to see the ENT a little earlier. This uncertainty is killing me!

THanks,
Svetlana
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657231_tn?1390151580
Actually, it was CSF, It just took a while to stop post op... but I stopped on my own - most people do.

Be glad you don't have the headache, take care - and rest up - you are probably still healing.
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Avatar_f_tn
It's fantastic that it stopped. How long did it take? Were you on bedrest or just taking it easy to help the leak stop on its own? Did doctors recommend any kind of intervention - lumbar spine drain or endoscopic surgery to close the leak?

Thank you!
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657231_tn?1390151580
Mine stopped after a few days after the hospital - my surgeon stayed on top of it. It went longer than it was supposed too and there was a medication to take but I could not get it and it stopped on its own. I did lay flat. I did not require surgery so I don't really consider mine much of a leak.
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Avatar_f_tn
Oh, so your leak only took place in the hospital. Was it clear or bloody?
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Avatar_f_tn
Did your surgeon suspect a CSF leak during the surgery?

If it stopped on its own, how do you know it was a leak as opposed to normal discharge? I had varying discharge, always bloody, while I was at the hospital and then for a week at home, but it was rarely as heavy as you described. The discharge is now clear and a very very slow trickle, only at certain times of the day/during certain activities.

Thanks!
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657231_tn?1390151580
Mine was clear. A leak was not suspected. It just did not stop after surgery and I had to keep wearing the gauze and the doc had me lay flat etc. and finally it cleared up. I would have taken the meds but the pharmacy people were all messed up with my insurance so I did not get it in time and then I did not need it! It was not fast - It was just persistent so I had to have something on my face as it was there or it would drip down my face.
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Avatar_m_tn
I just noticed this thread - pardon my late entry!

I had the same surgery just this April, for a non-functional pituitary macroadenoma.  I had no CSF leaks, but I did get a post-op sinus infection.  That was cleaered with antibiotics, but now, while I have no sinus pain or headaches, my sinuses feel "full" and about every 2-4 days I get a bad smell in my nose and a large semi-solid, messy green discharge.  Once it's gone I do feel better, but after a couple of days it happens again.  I will be seeing my neurosurtgeon again in about a month, but does anyone have any ideas?  
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985561_tn?1255203960
Hi Lana, this is Angelo from Athens Greece, I had an endoscopic surgery 3 years ago to remove a pituitary adenoma and they went in from my upper lip, I guss it pased from the nose also.
I was wearing gauze in my noze for a week to prevent dripping, then when I removed it was driping when looking down something that I was trying not to do, it was bloody in the beginig and and then after 2-3 days clear.
The neurosurtgeon asked me if a have a strange taste in my mouth and I told him no.
As far as the upper lip I could not feel it for more than 6-8 months, even my front upper teeth I could not feel them for more than a year.
As for the headaches, after two days from the surgery they disapear and the fany thing is that since then I dont have any headaches at all no mater what I do, hahaha I lost the headache feeling.
So dont worry the driping will stop,try not to look down.
Take care.
Angelo
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657231_tn?1390151580
The bad smell means you have an infection. It can be trapped way up there - so it may mean debridement or you may have a body that is clearing it hence the green discharge (green is infection). No one tells you after surgery that you will have scabs dropping out your nose the size of New Jersey - and so when it happens you are like WTF! but it is normal... sometimes they drop when you are not expecting and choke you a bit when you are talking or eating. I would contact your surgeon ASAP re infection and go see an ENT.

The other drip/strange taste is more looking for a CSF leak. I had a bit of a time stopping after my surgery as well - the gauze is a nice look, eh?
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Avatar_f_tn
I'm also joining the discussion a little late, but I have the exact same symptoms, Lana!  I just had resection of a pit tumor on 7/9, and over the past few days I've noticed a clear, slow discharge from my nose.  Not even enough to really drip onto my shirt or anything, but enough to have me walk around with a tissue dabbing my nose occasionally.  I think it happens more the more I move around, but leaning forward doesn't make it run more or pour out.  I'm also really sneezy (been able to suppress them, thank goodness)!  Also, the back of my throat/ears are itchy, and I think it may be a cold (my in-laws stayed with us two days before my surgery and both had colds).  Problem is my nose could run like this before surgery, so I'm having trouble figuring out what's going on.

Before discharge from the hospital, my neuro wanted to make sure there was no leak, and so I went to the ENT who looked up there and said everything was fine and that the site looked great.  I see him again next week.

Every morning since surgery I've woken up and, as soon as I sit up, I get a quick drainage of thin, yellowish liquid.  This then slowly turns clear as the day goes on.   There was much less of it today, thank goodness.  I really don't have a bad headache either...took tylenol this morning for the first time since yesterday afternoon.

I'm tempted just to keep an eye on it for now, especially since I don't have a bad headache.

I'd love to hear what happened with you (if you're still on this forum) and if it went away, since I feel like I have the exact same thing.

Thanks!
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657231_tn?1390151580
There are a couple of ways to determine if the discharge is CSF or um, snot...

One is if you have a glucose meter - CSF has sugar and mucus does not. Another way is to get a bit and put it on a coffee filter (as it has nice, thin absorbent paper) and CSF will spread out and form sort of circles like a halo effect will snot, will not.

Hopefully Veg will return but older posts may not get a response from the original person!
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Avatar_f_tn
gud day,im gelyn noynay from PHILIPPINES, i also had a pituitary macroadenoma and i under go ENDOSCOPIC TRANSSPHINOIDAL SURGERY,LAST FEB.2 2013 but until now i still can feel pain on my nose but not too much..and after a month of my operation i had my PROLACTINE TEST AGAIN,but im so disappointed of the result bec.its still not normal..and now first time after my operation i have this cough and colds and im scared bec.theres a blood on my mucus ...so my doctor said i have to under go a paranasal complete sinuses xray,but the result is negative??im so bother wat cause of the blood,.and its still possible for me to have a leak its been 5 months after my operation,.and is it normal to still pain on my nose until now??whats the symptoms if theres air on my brain
im really scared about that...please,.please and please do answer me..for me to stay calm about what happen..THANK YOU AND GOD BLESS
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657231_tn?1390151580
Hello...
Do you have a good ear/nose/throat doctor around? I would go see one of those. Did you? I am sorry but I cannot tell if you had the x-rays or are going to have the x-rays.

At this point, you should not still have blood and mucus. Surgical healing *should* have taken about a month. I was a very poor healer due to my disease and got a nasty infection. So you may have an infection (any smells, fever?)

As for pain, I had none at this point - so please see a doctor to check out your sinuses. It may be a bone not healing? What type of tumor did you have?

You would not have air in your brain. If you have a CSF leak, you would have very severe headaches. The headaches may feel better when you lay flat or when you have caffeine like coffee or colas.

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