In the event of the surgeon deciding to confine his attempts to palliative treatment--alleviation of symptoms only--the _subtemporal operation_ of Cushing is certainly the method of choice. The technique of the operation and its general advantages have already been discussed. It merely remains to add that, when the operation is conducted for tumour relief and not for injury as discussed in Chapter IV, no attempt is made to explore the temporo-sphenoidal lobe and drainage is contra-indicated. The dura, widely incised, is left open, the temporal muscle and fascia accurately sutured, and the scalp-flap secured with fine silk sutures. With regard to the side on which this subtemporal decompression operation is to be conducted, the best results are obtained by operating on that side on which the tumour is situated. In the event of doubt, the right side is chosen, so avoiding any possibility of including, in the hernial protrusion, the motor speech area of Broca. The cranial defect should be made as large as possible, and in the event of failure in bringing about adequate decompression, a similar operation is conducted at a later date on the opposite side of the skull. After subtemporal decompression there should be no mortality. The immediate results are eminently satisfactory--headache is relieved, optic neuritis steadily diminishes, vomiting ceases, and the general condition of the patient is immensely improved. The expectancy of life after such decompression operations requires careful consideration. So much depends on the nature of the tumour that it is difficult to make more than a general observation. In many cases life has been prolonged for one to two years, whilst instances are recorded in which the patient has lived for five to six years--not in a miserable condition as might be imagined, but in comparative comfort. It might be added that, as the tumour grows, a one-sided subtemporal decompression may gradually become insufficient. In such cases, recrudescence of symptoms--redevelopment of optic neuritis, &c.--may be met by further decompression on the opposite side of the head. =Operations for tumours of the pituitary body.= The pituitary body may be approached by the frontal, temporal, and nasal routes. The _temporal route_, advocated by Caton and Paul[49] and Horsley, possesses the disadvantage that the surgeon, whilst utilizing an approach similar to that used in the Hartley-Krause operation for trigeminal neuralgia, encounters on his way the structures laterally situated to the pituitary body, the internal carotid, the cavernous sinus, the third, fourth, and sixth nerves, and the ophthalmic division of the fifth. The anatomical difficulties are therefore considerable. Added to this, the tumour, in its hollowing out of the central portion of the sella turcica, may leave such lateral osseous walls that an approach from the side is impossible.