It’s a really huge tumour encasing the major arteries of the brain and circling both optic nerves,” I said to the family sitting in front of me. This is after I’ve been intently and repeatedly scrolling back and forth through the MRI images loaded on the computer in front of me. The growth was arising from the pituitary gland, but had invaded into the nose below and brain above, chewing up the bone at the base of the skull.

Betty, who had come in with her mother, was 48 and rapidly losing vision. She was finding it difficult to look after her five-year-old daughter not only because of her deteriorating vision, but also her decision making and executive functioning. “It’s probably due to the tumour pressing on the frontal lobe, which is responsible for these functions,” I said. “We’ll have to operate on this through the nose and by opening up the head simultaneously. It’s going to be a major deal.”