[History of pituitary surgery]

Abstract

Over the last few decades, the scientific literature has acquired over 100 publications on pituitary surgery. Most of these papers contain a brief historical review of the work of the pioneers who contributed to operative modalities (Landolt et al., 1996; Liu et al., 2001; Walker, 1951; Welbourne, 1986). Several have been only experimental explorations on cadavers, used on a few patients, but were eventually abandoned, retaining only anecdotal value. In fact, open surgery currently uses the two classical approaches: intracranial and extracranial. The superior transcranial approach has retained two modalities: (1) subfrontal basal with or without resection of the orbital ridge and (2) subfrontal or subfrontotemporal. The inferior trans-sphenoidal approach currently maintains two modalities: (1) endonasal lateral submucosal or Kocher-Hirsch extramucosal and (2) sublabial midline rhinoseptal of Halstead-Cushing. Further development with various instruments has improved the operative procedure. Microsurgical exploration of the hypophysis can now identify intrapituitary microadenomas, thus allowing selective microadenomectomy, which constitutes the ultimate achievement in the surgical treatment of endocrinological hyperpituitarism syndromes.