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Your questions answered

Pituitary tumour removal

As surgeon Nick Thomas carefully removed a tumour from Catherine's pituitary gland by entering through the nose, questions flooded it. They ranged from what would happen if the patient had a blocked up nose, to how you tell the difference between the pituitary gland and the tumour.

During the programme, slive was the most buzzing word on Twitter, seen using Twitscoop.

Here is a selection of questions that were answered on the night. Surgeon Nick Thomas also kindly answered more of your questions especially for this website.

Is going through the nose the only way to access the pituitary gland? (Debby Cullen, by phone)

'That's a very good question. The answer is no. Even though most of the operations we do are through the nose, there are still a number of cases that we need to do by opening up the scalp from the skull, lifting up the front bit of the brain, and accessing the pituitary that way. It just depends a little bit upon how the tumour looks. Sometimes it's just not amenable to do through the nose. Now, that was the way getting to the pituitary gland was originally done, back in the 1880s, so a long, long time ago. Going through the nose was popularised in the early 1900s and with the development of an operating microscope, one of which you can see in the corner of the operating theatres here and now more recently, the endoscope, we've been able to access more and more tumours with better visualisation through the nose. The analogy I would use, when trying to compare what one can do with a microscope and with an endoscope is rather like saying, with a microscope you can look through the letterbox and into the front room even with a lot of magnification, but you can't actually get into the front room, whereas with a scope you can actually pass it through the letterbox and into the front room and you can actually look around.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

What happens if the patient has a blocked-up nose? (via Twitter)

'If they've got an obvious source of infection, it would be imprudent to go through it and operate, because you run the risk of developing a greater chance of infection in the brain, or a meningitis, but the nose is a remarkably privileged access route and it's unusual to get that. Otherwise if it's just a bit of a dirty nose, we can cope with that.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

Would there have been any upside of Christine's excess growth hormone? Presumably in old age she'll be less susceptible to frailty and osteoporosis. (by the audience)

'Growth hormone's important for growing upwards when you're young, for filling out in your twenties, but it remains an important metabolic hormone, throughout life. What that means is that without adequate growth hormone, you tend to get tired, run out of energy, run out of steam. I don't think she would've had any benefit from having increased amounts.'

Simon Aylwin, endocrinologist, King's College Hospital

How can you tell the difference between the tumour and the pituitary gland, when you're cutting? (via Twitter)

'That's an excellent question. The way it works out is absolutely fantastic for us, in that the normal pituitary gland, if it's around, and with a size tumour of this sort, it may very well be the case is more solid and more difficult to scrape out, whereas the tumour is much softer, and so essentially, if anything's going to happen, it's that the good bits stay in and the bad bits come out. The normal pituitary gland is a bit more yellow, so you can differentiate between the normal gland and tumour in consistency and colour.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

Will the patient's feet return to their original size after the surgery? (Anna Young, by phone)

'Probably not. Things should stop getting bigger, the soft tissues, and generally how the patient feels will improve, but there are some changes which are permanent and don't improve. One of the other issues that can be affected is cartilage, and that gets disorganised and grows rather poorly, can cause arthritis problems in other joints, but that will also make up a certain amount of the foot, so there's a bit of bone that may have changed, but mostly those harder tissues will remain a little bit larger than they started, a bit better, not completely resolved.'

Simon Aylwin, endocrinologist, King's College Hospital

If you hit a main nerve in the brain will it affect either the movement or any other part of the body? (via email)

'Well, the nerves just at the top of the pituitary tumour are the nerves going to the eyes, so impairment of vision, or blindness, is a recognised risk, albeit a low risk, percentage-wise, of the operation. Another part of the brain that's very close to where the pituitary gland is, can affect level of consciousness, control of body temperature and the salts in the blood, and affecting that bit of the brain can cause a diminished level of consciousness, and indeed carries a risk to life, but not really a stroke, in terms of what one understands the term to mean in terms of weakness down one side of the body or the other.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

Will this operation hurt the patient's nose or affect smelling senses afterwards at all? (via Twitter)

'Smelling should not be affected because we haven't damaged the nerves that assist smelling, and generally the pain is low, can be controlled with simple painkillers.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

Would it be possible to have the pituitary tumour removal without being anesthetised as sometimes it is possible to have operations done by hypnosis or by listening to calming music? (via email)

'The answer to that one is no. It would be difficult to have somebody so immobilised for that period of time, with such delicate surgery.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

Do all pituitary tumours require surgery to remove? Can they be benign? (via Twitter)

'The overwhelming majority of them are actually inherently benign, although the symptoms that they can cause and the risks to the body in general can be far from benign, but they are not cancerous growths, and not all of them do require surgery, some of them are very responsive to medical tablet treatment.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

Is there a risk that the removal of this tumour would stop the body from growing new bone to fix any breaks that the patient may get? (via Twitter)

'The answer to that is that the patients have appropriate hormone replacement after surgery, so the straight answer is no.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

How many of these surgeries do you do in a week? (via Twitter)

'Well it varies from week to week, but roughly 110 pituitary region tumours a year.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)

How stressed do you get when doing your job? Have you ever monitored your own heart rate when operating? (via Twitter)

'Generally I can keep my stress levels under control, although when an operation is difficult, it can be very stressful, but the most important thing to do is just to take stock of what's going on and stop getting anxious otherwise it only makes the situation worse.'

Nick Thomas, neurosurgeon, King's College Hospital (while operating)


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