Mr Robert Battersby
Royal Hallamshire Hospital, Sheffield

Mr Battersby provided a neurosurgical perspective on the development of surgical treatment for pituitary tumours. He discussed the discovery of Transsphenoidal surgery by Harvey Cushing (who performed the surgery with a light strapped to his forehead) through to the development of modern day surgery by Roger Guillot in Paris in the 1960s and then Jules Hardy in Montreal. The transnasal (up the nose) route is the most usual form of treatment nowadays. Mr Battersby performs about 20-30 pituitary operations a year. The development of clinical networks in different parts of the country should ensure that specialist pituitary surgeons perform at least this number of operations per year, serving a population of about 5 million patients.

Patients with pituitary tumours present either with endocrine problems, headaches or visual disturbances, sometimes with a sudden Apoplexy (haemorrhage into their Pituitary tumour) or rarely extension of the tumour into the cavernous sinus in the head where it can interfere with nerves which control eye movement. Some patients can have tumours that exist for many years without causing any trouble and these don't need surgery. In other cases, surgery is vital to protect vision and prevent further damage to the Pituitary gland.

Complications can occur following pituitary surgery. Operating is not like repairing a washing machine; if anything went wrong with a washing machine, you could simply throw it out but this is not the same with patients! Diabetes Insipidus is a common problem after surgery but is usually transient. Hypopituitarism (loss of normal hormone secretion by the pituitary gland) is also quite common and dependent on the size of the tumour. Fluid around the brain can leak down the nose and can increase susceptibility to infections and meningitis.

Most people feel better after surgery, often simply because of the relief of pressure in the pituitary gland, but hormone replacement therapy and decreased headaches are also a great help.

Mr Battersby clearly disagrees with endocrinologists about the treatment of small prolactinomas. The great majority of endocrinologists believe they should be treated with cabergoline or Bromocriptine, whereas he believed that curative treatment with surgery would be in many patients' interests. He did admit that this was a surgical opinion! He went on to tell us how 70-80% of acromegalics and about 50% of patients with Cushing's should be cured by surgery. Nowadays, 43% of his patients stayed in hospital for less than 7 days, 47% between 1 and 2 weeks and 10% more than 2 weeks.

In conclusion, Mr Battersby felt that pituitary surgery was safe and well tolerated. It was the treatment of choice for non-functional tumours. New techniques are improving localisation of tumours, which makes surgery easier. Although he described endoscopic surgery, it was not a technique that he was performing himself even though other centres in the UK were achieving very good results. He also felt the role of Radiotherapy and stereotactic radio surgery needed further development. Finally, Mr Battersby showed a video of a transsphenoidal and a transfrontal (under the brain) operation on the pituitary. Fortunately none of the audience vomited or fainted - even those awaiting surgery!