Transsphenoidal Approaches

Abstract

At the beginning of our century, in 1906, Schloffer was the first to describe an extradural approach to the pituitary gland (Schloffer 1906, 1907), and thus became a pioneer of numerous similar approaches with the common goal of removing pituitary adenomas without craniotomy, for in those days subfrontal craniotomy caused much greater strain and risk for the patient than now. Following that innovative step, as is often the case, a variety of similar extradural approaches to the pituitary gland were developed. Most interesting among them and most frequently used up to today are the endonasal approach as described by Hirsch (1909, 1910, 1958) and the transethmoidal approach of Chiari (1912). The transpalatal approach described by Tiefenthal in 1920 and the transmaxillary approach of Fein (1910), later on modified by Denker (1921) and Lautenschläger (1929), are no longer in commonly use. Archer et al. (1987) described a transclival approach after bilateral maxillotomy, to clip aneurysms of the vertebrobasilar system. The approach most frequently employed in neurosurgery today, the sublabial-transseptal-transsphenoidal approach, was developed by Cushing as early as 1912 and combines optimal cosmetic results with strictly midline dissection. Guiot, who championed this technique, continued its development and performed surgery under the microscope (Guiot 1958, Guiot and Thibaut 1958; Guiot and Derome 1976).