Endoscopic Endonasal trans-sphenoid surgery for pituitary tumours- past, present and future

Abstract

Dear Editor,

Pituitary adenomas, which account for up to 20% of primary intracranial tumours, are known for their slow growth and diverse subtypes, categorized as non-functioning and functioning adenomas. They may manifest incidentally or with mass effects like visual decline or hormonal imbalances such as Cushing's disease, acromegaly, etc., potentially leading to significant health complications or mortality if left untreated. [1]

The history of pituitary surgery spans over a century. In the late 1800s and early 1900s, trans-cranial approaches to the pituitary gland were attempted, but they carried a high mortality rate. Schloffer proposed the transsphenoidal route as a safer option for accessing the sella turcica, achieving the first successful removal of a pituitary tumour using this approach in 1906. Surgeons further refined this technique, with Halstead describing a sub-labial gingival incision in 1910. Meanwhile, Norman Dott persisted with the transsphenoidal approach in Scotland, later introducing it to Gerard Guiot, who innovated further by incorporating radio fluoroscopic control and cisternal pneumography for enhanced visualization and tumour removal. Jules Hardy later refined the transsphenoidal approach by introducing the operating microscope, thereby improving its effectiveness and reducing surgical complications. [2]