The history and evolution of transsphenoidal surgery

View More View Less
  • 1 Department of Neurosurgery, New York Medical College, Valhalla and New York, New York; Department of Neurosurgery, University of Southern California, Los Angeles, California; and Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ Initial attempts at transcranial approaches to the pituitary gland in the late 1800s and early 1900s resulted in a mortality rate that was generally considered prohibitive. Schloffer suggested the use of a transsphenoidal route as a safer, alternative approach to the sella turcica. He reported the first successful removal of a pituitary tumor via the transsphenoidal approach in 1906. His procedure underwent a number of modifications by interested surgeons, the culmination of which was A. E. Halstead's description in 1910 of a sublabial gingival incision for the initial stage of exposure. From 1910 to 1925, Cushing, combining a number of suggestions made by previous authors, refined the transsphenoidal approach and used it to operate on 231 pituitary tumors, with a mortality rate of 5.6%. As he developed increasing expertise with transcranial surgery, however, Cushing reduced his mortality rate to 4.5%. With the transcranial approach, he was able to verify suprasellar tumors and achieve better decompression of the optic apparatus, resulting in better recovery of vision and a lower recurrence rate. As a result he and most other neurosurgeons at the time abandoned the transnasal in favor of the transcranial approaches.

Norman Dott, a visiting scholar who studied with Cushing in 1923, returned to Edinburgh, Scotland, and continued to use the transsphenoidal procedure while others pursued transcranial approaches. Dott introduced the procedure to Gerard Guiot, who published excellent results with the transsphenoidal approach and revived the interest of many physicians throughout Europe in the early 1960s. Jules Hardy, who used intraoperative fluoroscopy while learning the transsphenoidal approach from Guiot, then introduced the operating microscope to further refine the procedure; he thereby significantly improved its efficacy and decreased surgical morbidity. With the development of antibiotic drugs and modern microinstrumentation, the transsphenoidal approach became the preferred route for the removal of lesions that were confined to the sella turcica. The evolution of the transsphenoidal approaches and their current applications and modifications are discussed.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: William T. Couldwell, M.D., Ph.D., Department of Neurosurgery, New York Medical College, Munger Pavilion, Valhalla, New York 10595. email: william_couldwell@nymc.edu.
  • 1.

    Alfieri A: Endoscopic endonasal transsphenoidal approach to the sellar region: technical evolution of the methodology and refinement of a dedicated instrumentation. J Neurosurg Sci 43:8592, 1999 Alfieri A: Endoscopic endonasal transsphenoidal approach to the sellar region: technical evolution of the methodology and refinement of a dedicated instrumentation. J Neurosurg Sci 43:85–92, 1999

    • Search Google Scholar
    • Export Citation
  • 2.

    Arita K, , Kurisu K, & Tomainaga A, et al: Trans-sellar color Doppler ultrasonography during transsphenoidal surgery. Neurosurgery 42:8186, 1998 Arita K, Kurisu K, Tomainaga A, et al: Trans-sellar color Doppler ultrasonography during transsphenoidal surgery. Neurosurgery 42:81–86, 1998

    • Search Google Scholar
    • Export Citation
  • 3.

    Artico M, , Pastore FS, & Fraioli B, et al: The contribution of Davide Giordano (1864–1954) to pituitary surgery: the transglabellar-nasal approach. Neurosurgery 42:909912, 1998 Artico M, Pastore FS, Fraioli B, et al: The contribution of Davide Giordano (1864–1954) to pituitary surgery: the transglabellar-nasal approach. Neurosurgery 42:909–912, 1998

    • Search Google Scholar
    • Export Citation
  • 4.

    Biggart JH, & Dott NM: Pituitary tumours. Their classification and treatment. BMJ 2:12061208, 1936 Biggart JH, Dott NM: Pituitary tumours. Their classification and treatment. BMJ 2:1206–1208, 1936

    • Search Google Scholar
    • Export Citation
  • 5.

    Black PMcL, , Zervas NT, & Candia GL: Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920924, 1987 Black PMcL, Zervas NT, Candia GL: Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920–924, 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Broeckaert J: A contribution to the surgery of the hypophysis. J Laryngol 28:340352, 1913 Broeckaert J: A contribution to the surgery of the hypophysis. J Laryngol 28:340–352, 1913

    • Search Google Scholar
    • Export Citation
  • 7.

    Bushe KA, & Halves E: Modifizierte Technik bei transnasaler Operation der Hypophysengeschwulste. Acta Neurochir 41:163175, 1978 Bushe KA, Halves E: Modifizierte Technik bei transnasaler Operation der Hypophysengeschwulste. Acta Neurochir 41:163–175, 1978

    • Search Google Scholar
    • Export Citation
  • 8.

    Cappabianca P, , Alfieri A, & Thermes S, et al: Instruments for endoscopic endonasal transsphenoidal surgery. Neurosurgery 45:392396, 1999 Cappabianca P, Alfieri A, Thermes S, et al: Instruments for endoscopic endonasal transsphenoidal surgery. Neurosurgery 45:392–396, 1999

    • Search Google Scholar
    • Export Citation
  • 9.

    Carrau RL, , Jho HD, & Ko Y: Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914918, 1996 Carrau RL, Jho HD, Ko Y: Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914–918, 1996

    • Search Google Scholar
    • Export Citation
  • 10.

    Caton R, & Paul FT: Notes of a case of acromegaly treated by operation. BMJ 2:14211423, 1893 Caton R, Paul FT: Notes of a case of acromegaly treated by operation. BMJ 2:1421–1423, 1893

    • Search Google Scholar
    • Export Citation
  • 11.

    Chiari O: Ueber eine Modifikation der Schlofferschen Operation von Tumoren der Hypophyse. Wien Klin Wchnschr 25:56, 1912 Chiari O: Ueber eine Modifikation der Schlofferschen Operation von Tumoren der Hypophyse. Wien Klin Wchnschr 25:5–6, 1912

    • Search Google Scholar
    • Export Citation
  • 12.

    Ciric IS, , Ragin A, & Baumgartner C, et al: Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225237, 1997 Ciric IS, Ragin A, Baumgartner C, et al: Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225–237, 1997

    • Search Google Scholar
    • Export Citation
  • 13.

    Collins WF: Hypophysectomy: historical and personal perspective. Clin Neurosurg 21:6878, 1974 Collins WF: Hypophysectomy: historical and personal perspective. Clin Neurosurg 21:68–78, 1974

    • Search Google Scholar
    • Export Citation
  • 14.

    Cope VZ: The pituitary fossa, and the methods of surgical approach thereto. Br J Surg 4:107144, 1916 Cope VZ: The pituitary fossa, and the methods of surgical approach thereto. Br J Surg 4:107–144, 1916

    • Search Google Scholar
    • Export Citation
  • 15.

    Couldwell WT, , Simard MF, & Weiss MH: Surgical management of growth hormone-secreting and prolactin-secreting pituitary adenomas, in Schmidek HH, & Sweet WH (eds): Operative Neurosurgical Techniques: Indications, Methods, and Results, ed 3. Philadelphia: WB Saunders, 1995, pp 305313 Couldwell WT, Simard MF, Weiss MH: Surgical management of growth hormone-secreting and prolactin-secreting pituitary adenomas, in Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques: Indications, Methods, and Results, ed 3. Philadelphia: WB Saunders, 1995, pp 305–313

    • Search Google Scholar
    • Export Citation
  • 16.

    Couldwell WT, , Simard MF, & Weiss MH, et al: Pituitary and adrenal, in Schwartz SI, , Shires GT, & Spencer FC (eds): Principles of Surgery, ed 7. New York: McGraw-Hill, 1999, pp 16131659 Couldwell WT, Simard MF, Weiss MH, et al: Pituitary and adrenal, in Schwartz SI, Shires GT, Spencer FC (eds): Principles of Surgery, ed 7. New York: McGraw-Hill, 1999, pp 1613–1659

    • Search Google Scholar
    • Export Citation
  • 17.

    Couldwell WT, & Weiss MH: Strategies for the management of nonsecreting pituitary adenomas, in Cooper PR (ed): Contemporary Diagnosis and Management of Pituitary Adenomas. Park Ridge, IL: AANS, 1991, pp 2935 Couldwell WT, Weiss MH: Strategies for the management of nonsecreting pituitary adenomas, in Cooper PR (ed): Contemporary Diagnosis and Management of Pituitary Adenomas. Park Ridge, IL: AANS, 1991, pp 29–35

    • Search Google Scholar
    • Export Citation
  • 18.

    Couldwell WT, & Weiss MH: The transnasal transsphenoidal approach, in Apuzzo MLJ (ed): Surgery of the Third Ventricle, ed 2. Baltimore: Williams & Wilkins, 1998, pp 553574 Couldwell WT, Weiss MH: The transnasal transsphenoidal approach, in Apuzzo MLJ (ed): Surgery of the Third Ventricle, ed 2. Baltimore: Williams & Wilkins, 1998, pp 553–574

    • Search Google Scholar
    • Export Citation
  • 19.

    Cushing H: Partial hypophysectomy for acromegaly. With remarks on the function of the hypophysis. Ann Surg 50:10021017, 1909 Cushing H: Partial hypophysectomy for acromegaly. With remarks on the function of the hypophysis. Ann Surg 50:1002–1017, 1909

    • Search Google Scholar
    • Export Citation
  • 20.

    Cushing H: The Pituitary Body and Its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri. Philadelphia: JB Lippincott, 1912, pp 296305 Cushing H: The Pituitary Body and Its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri. Philadelphia: JB Lippincott, 1912, pp 296–305

    • Search Google Scholar
    • Export Citation
  • 21.

    Cushing H: The Weir Mitchell Lecture. Surgical experiences with pituitary disorders. JAMA 63:15151525, 1914 Cushing H: The Weir Mitchell Lecture. Surgical experiences with pituitary disorders. JAMA 63:1515–1525, 1914

    • Search Google Scholar
    • Export Citation
  • 22.

    Dandy WE: A new hypophysis operation. Bull Johns Hopkins Hosp 29:154, 1918 Dandy WE: A new hypophysis operation. Bull Johns Hopkins Hosp 29:154, 1918

    • Search Google Scholar
    • Export Citation
  • 23.

    Dott NM, & Bailey P: A consideration of the hypophyseal adenomata. Br J Surg 13:314366, 1925 Dott NM, Bailey P: A consideration of the hypophyseal adenomata. Br J Surg 13:314–366, 1925

    • Search Google Scholar
    • Export Citation
  • 24.

    Elias WJ, , Chadduck JB, & Alden TD, et al: Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 45:271277, 1999 Elias WJ, Chadduck JB, Alden TD, et al: Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 45:271–277, 1999

    • Search Google Scholar
    • Export Citation
  • 25.

    Elsberg CA: Tumor of the hypophysis. Ann Surg 59:454455, 1914 Elsberg CA: Tumor of the hypophysis. Ann Surg 59:454–455, 1914

  • 26.

    Fraioli B, , Esposito V, & Santoro A, et al: Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 82:6369, 1995 Fraioli B, Esposito V, Santoro A, et al: Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 82:63–69, 1995

    • Search Google Scholar
    • Export Citation
  • 27.

    Frazier CH: An approach to the hypophysis through the anterior cranial fossa. Ann Surg 57:145150, 1913 Frazier CH: An approach to the hypophysis through the anterior cranial fossa. Ann Surg 57:145–150, 1913

    • Search Google Scholar
    • Export Citation
  • 28.

    Frazier CH: Choice of method in operations upon the pituitary body. Surg Gynecol Obstet 29:916, 1919 Frazier CH: Choice of method in operations upon the pituitary body. Surg Gynecol Obstet 29:9–16, 1919

    • Search Google Scholar
    • Export Citation
  • 29.

    Freda PU, , Wardlaw SL, & Post KD: Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 89:353358, 1998 Freda PU, Wardlaw SL, Post KD: Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 89:353–358, 1998

    • Search Google Scholar
    • Export Citation
  • 30.

    Giordano F: Compendio di Chirurgia Operativa Italiana, ed 2. Torino, Italy: UTET, 1911 (Reference unverified) Giordano F: Compendio di Chirurgia Operativa Italiana, ed 2. Torino, Italy: UTET, 1911 (Reference unverified)

    • Search Google Scholar
    • Export Citation
  • 31.

    Guiot G: Considerations on the surgical treatment of pituitary adenomas, in Fahlbusch R, & Werder KV (eds): Treatment of Pituitary Adenomas. 1st European Workshop. Stuttgart: Thieme, 1978, pp 202218 (Reference unverified) Guiot G: Considerations on the surgical treatment of pituitary adenomas, in Fahlbusch R, Werder KV (eds): Treatment of Pituitary Adenomas. 1st European Workshop. Stuttgart: Thieme, 1978, pp 202–218 (Reference unverified)

    • Search Google Scholar
    • Export Citation
  • 32.

    Guiot G: Transsphenoidal approach in surgical treatment of pituitary adenomas: general principles and indications in nonfunctioning adenomas, in Kohler PO, & Ross GT (eds): Diagnosis and Treatment of Pituitary Tumors. New York: American Elsevier, 1973, pp 159178 (Reference unverified) Guiot G: Transsphenoidal approach in surgical treatment of pituitary adenomas: general principles and indications in nonfunctioning adenomas, in Kohler PO, Ross GT (eds): Diagnosis and Treatment of Pituitary Tumors. New York: American Elsevier, 1973, pp 159–178 (Reference unverified)

    • Search Google Scholar
    • Export Citation
  • 33.

    Guiot G, & Thibaut B: L'extirpation des adénomes hypophysaires par voie trans-sphenoidale. Neurochirurgia 1:133150, 1959 Guiot G, Thibaut B: L'extirpation des adénomes hypophysaires par voie trans-sphenoidale. Neurochirurgia 1:133–150, 1959

    • Search Google Scholar
    • Export Citation
  • 34.

    Halstead AE: Remarks on the operative treatment of tumors of the hypophysis. With the report of two cases operated on by an oro-nasal method. Surg Gynecol Obstet 10:494502, 1910 Halstead AE: Remarks on the operative treatment of tumors of the hypophysis. With the report of two cases operated on by an oro-nasal method. Surg Gynecol Obstet 10:494–502, 1910

    • Search Google Scholar
    • Export Citation
  • 35.

    Hamlin H: The case for transsphenoidal approach to hypophyseal tumors. J Neurosurg 19:10001003, 1962 Hamlin H: The case for transsphenoidal approach to hypophyseal tumors. J Neurosurg 19:1000–1003, 1962

    • Search Google Scholar
    • Export Citation
  • 36.

    Hamlin H: Oskar Hirsch. Surg Neurol 16:391393, 1981 Hamlin H: Oskar Hirsch. Surg Neurol 16:391–393, 1981

  • 37.

    Hardy J: [Exercision of pituitary adenomas by trans-sphenoidal approach.] Union Med Canada 91:933945, 1962 (Fr) Hardy J: [Exercision of pituitary adenomas by trans-sphenoidal approach.] Union Med Canada 91:933–945, 1962 (Fr)

    • Search Google Scholar
    • Export Citation
  • 38.

    Hardy J: Neurosurgeon of the year: Gerard Guiot. Surg Neurol 11:12, 1979 Hardy J: Neurosurgeon of the year: Gerard Guiot. Surg Neurol 11:1–2, 1979

    • Search Google Scholar
    • Export Citation
  • 39.

    Hardy J: [Surgery of the pituitary gland, using the trans-sphenoidal approach. Comparative study of 2 technical methods.] Union Med Canada 96:702712, 1967 (Fr) Hardy J: [Surgery of the pituitary gland, using the trans-sphenoidal approach. Comparative study of 2 technical methods.] Union Med Canada 96:702–712, 1967 (Fr)

    • Search Google Scholar
    • Export Citation
  • 40.

    Hardy J: Transsphenoidal hypophysectomy. J Neurosurg 34:582594, 1971 Hardy J: Transsphenoidal hypophysectomy. J Neurosurg 34:582–594, 1971

    • Search Google Scholar
    • Export Citation
  • 41.

    Hardy J: Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185217, 1969 Hardy J: Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185–217, 1969

    • Search Google Scholar
    • Export Citation
  • 42.

    Hardy J, & Wigser SM: Trans-sphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control. J Neurosurg 23:612619, 1965 Hardy J, Wigser SM: Trans-sphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control. J Neurosurg 23:612–619, 1965

    • Search Google Scholar
    • Export Citation
  • 43.

    Henderson WR: The pituitary adenomata. A follow-up study of the surgical results in 338 cases (Dr. Harvey Cushing's series). Br J Surg 26:811921, 1939 Henderson WR: The pituitary adenomata. A follow-up study of the surgical results in 338 cases (Dr. Harvey Cushing's series). Br J Surg 26:811–921, 1939

    • Search Google Scholar
    • Export Citation
  • 44.

    Heuer GJ: The surgical approach and the treatment of tumors and other lesions about the optic chiasm. Surg Gynecol Obstet 53:489518, 1931 Heuer GJ: The surgical approach and the treatment of tumors and other lesions about the optic chiasm. Surg Gynecol Obstet 53:489–518, 1931

    • Search Google Scholar
    • Export Citation
  • 45.

    Hirsch O: Endonasal method of removal of hypophyseal tumors. With a report of two successful cases. JAMA 55:772774, 1910 Hirsch O: Endonasal method of removal of hypophyseal tumors. With a report of two successful cases. JAMA 55:772–774, 1910

    • Search Google Scholar
    • Export Citation
  • 46.

    Hirsch O: Life-long cures and improvements after transsphenoidal operation of pituitary tumors. (Thirty-three patients, followed-up for 20–37 years). Acta Ophthal Suppl 56:160, 1959 Hirsch O: Life-long cures and improvements after transsphenoidal operation of pituitary tumors. (Thirty-three patients, followed-up for 20–37 years). Acta Ophthal Suppl 56:1–60, 1959

    • Search Google Scholar
    • Export Citation
  • 47.

    Hirsch O: Symptoms and treatment of pituitary tumors. Arch Otolaryngol 55:268306, 1952 Hirsch O: Symptoms and treatment of pituitary tumors. Arch Otolaryngol 55:268–306, 1952

    • Search Google Scholar
    • Export Citation
  • 48.

    Horsley V: On the technique of operations on the central nervous system. BMJ 2:411423, 1906 Horsley V: On the technique of operations on the central nervous system. BMJ 2:411–423, 1906

    • Search Google Scholar
    • Export Citation
  • 49.

    Horwitz NH: Library: historical perspective: Norman M. Dott (1897–1973). Neurosurgery 45:944948, 1999 Horwitz NH: Library: historical perspective: Norman M. Dott (1897–1973). Neurosurgery 45:944–948, 1999

    • Search Google Scholar
    • Export Citation
  • 50.

    Jho HD, & Carrau RL: Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:4451, 1997 Jho HD, Carrau RL: Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51, 1997

    • Search Google Scholar
    • Export Citation
  • 51.

    Jho HD, , Carrau RL, & Ko Y, et al: Endoscopic pituitary surgery: an early experience. Surg Neurol 47:213223, 1997 Jho HD, Carrau RL, Ko Y, et al: Endoscopic pituitary surgery: an early experience. Surg Neurol 47:213–223, 1997

    • Search Google Scholar
    • Export Citation
  • 52.

    Kanavel AB: The removal of tumors of the pituitary body by an infranasal route. A proposed operation with a description of the technic. JAMA 53:17041707, 1909 Kanavel AB: The removal of tumors of the pituitary body by an infranasal route. A proposed operation with a description of the technic. JAMA 53:1704–1707, 1909

    • Search Google Scholar
    • Export Citation
  • 53.

    Kennedy DW, , Cohn ES, & Papel ID, et al: Transsphenoidal approach to the sella: the Johns Hopkins experience. Laryngoscope 94:10661074, 1984 Kennedy DW, Cohn ES, Papel ID, et al: Transsphenoidal approach to the sella: the Johns Hopkins experience. Laryngoscope 94:1066–1074, 1984

    • Search Google Scholar
    • Export Citation
  • 54.

    Kiliani OGT: Some remarks on tumors of the chiasm, with a proposal how to reach the same by operation. Ann Surg 40:3543, 1904 Kiliani OGT: Some remarks on tumors of the chiasm, with a proposal how to reach the same by operation. Ann Surg 40:35–43, 1904

    • Search Google Scholar
    • Export Citation
  • 55.

    Kocher T: Ein Fall von Hypophysis tumor mit operativer Heilung. Dtsch Z Chir 100:1337, 1909 Kocher T: Ein Fall von Hypophysis tumor mit operativer Heilung. Dtsch Z Chir 100:13–37, 1909

    • Search Google Scholar
    • Export Citation
  • 56.

    Kouri JG, , Chen MY, & Watson JC, et al: Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92:10281035, 2000 Kouri JG, Chen MY, Watson JC, et al: Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92:1028–1035, 2000

    • Search Google Scholar
    • Export Citation
  • 57.

    Krause F: Hirnchirurgie. Dtsch Klin 8:9531024, 1905 Krause F: Hirnchirurgie. Dtsch Klin 8:953–1024, 1905

  • 58.

    Laws ER Jr: Comment on Jho HD, Carrau RL, Ko Y, et al: Endoscopic pituitary surgery: an early experience. Surg Neurol 47:213223, 1997 Laws ER Jr: Comment on Jho HD, Carrau RL, Ko Y, et al: Endoscopic pituitary surgery: an early experience. Surg Neurol 47:213–223, 1997

    • Search Google Scholar
    • Export Citation
  • 59.

    Laws ER Jr: Comment on Rodziewicz GS, Kelley RT, Kellman RM, et al: Transnasal endoscopic surgery of the pituitary gland: technical note. Neurosurgery 39:189193, 1996 Laws ER Jr: Comment on Rodziewicz GS, Kelley RT, Kellman RM, et al: Transnasal endoscopic surgery of the pituitary gland: technical note. Neurosurgery 39:189–193, 1996

    • Search Google Scholar
    • Export Citation
  • 60.

    Laws ER Jr: Pituitary surgery. Endocrin Metab Clin 16:647665, 1987 Laws ER Jr: Pituitary surgery. Endocrin Metab Clin 16:647–665, 1987

    • Search Google Scholar
    • Export Citation
  • 61.

    Laws ER Jr: Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52:661666, 1980 Laws ER Jr: Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52:661–666, 1980

    • Search Google Scholar
    • Export Citation
  • 62.

    Laws ER Jr, & Kern EB: Complications of trans-sphenoidal surgery. Clin Neurosurg 23:401416, 1976 Laws ER Jr, Kern EB: Complications of trans-sphenoidal surgery. Clin Neurosurg 23:401–416, 1976

    • Search Google Scholar
    • Export Citation
  • 63.

    Laws ER Jr, , Piepgras DG, & Randall RV, et al: Neurosurgical management of acromegaly. Results in 82 patients treated between 1972 and 1977. J Neurosurg 50:454461, 1979 Laws ER Jr, Piepgras DG, Randall RV, et al: Neurosurgical management of acromegaly. Results in 82 patients treated between 1972 and 1977. J Neurosurg 50:454–461, 1979

    • Search Google Scholar
    • Export Citation
  • 64.

    Luft R, & Olivecrona H: Experiences with hypophysectomy in man. J Neurosurg 10:301316, 1953 Luft R, Olivecrona H: Experiences with hypophysectomy in man. J Neurosurg 10:301–316, 1953

    • Search Google Scholar
    • Export Citation
  • 65.

    Marie P: Sur deux cas d'acromégalie: hypertrophie singulière non congénitale, des extrémités supérieures, inférieures, et cephalique. Rev Med 6:297333, 1886 Marie P: Sur deux cas d'acromégalie: hypertrophie singulière non congénitale, des extrémités supérieures, inférieures, et cephalique. Rev Med 6:297–333, 1886

    • Search Google Scholar
    • Export Citation
  • 66.

    Mason RB, , Nieman LK, & Doppman JL, et al: Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg 87:343351, 1997 Mason RB, Nieman LK, Doppman JL, et al: Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg 87:343–351, 1997

    • Search Google Scholar
    • Export Citation
  • 67.

    McArthur LL: An aseptic surgical access to the pituitary body and its neighborhood. JAMA 58:20092011, 1912 McArthur LL: An aseptic surgical access to the pituitary body and its neighborhood. JAMA 58:2009–2011, 1912

    • Search Google Scholar
    • Export Citation
  • 68.

    Mixter SJ, & Quackenboss A: Tumor of the hypophysis (with infantilism). Ann Surg 52:1522, 1910 Mixter SJ, Quackenboss A: Tumor of the hypophysis (with infantilism). Ann Surg 52:15–22, 1910

    • Search Google Scholar
    • Export Citation
  • 69.

    Rabb CH, , Couldwell WT, & Weiss MH: Pituitary tumors: anatomy and surgical approach, in Tindall GT, , Cooper PR, & Barrow DL (eds): The Practice of Neurosurgery. Baltimore: Williams & Wilkins, 1996, pp 11211134 Rabb CH, Couldwell WT, Weiss MH: Pituitary tumors: anatomy and surgical approach, in Tindall GT, Cooper PR, Barrow DL (eds): The Practice of Neurosurgery. Baltimore: Williams & Wilkins, 1996, pp 1121–1134

    • Search Google Scholar
    • Export Citation
  • 70.

    Ray BS, & Pearson OH: Hypophysectomy in the treatment of advanced cancer of breast. Ann Surg 144:394403, 1956 Ray BS, Pearson OH: Hypophysectomy in the treatment of advanced cancer of breast. Ann Surg 144:394–403, 1956

    • Search Google Scholar
    • Export Citation
  • 71.

    Rosegay H: Cushing's legacy to transsphenoidal surgery. J Neurosurg 54:448454, 1981 Rosegay H: Cushing's legacy to transsphenoidal surgery. J Neurosurg 54:448–454, 1981

    • Search Google Scholar
    • Export Citation
  • 72.

    Sabit I, , Schaefer SD, & Couldwell WT: Extradural extranasal combined transmaxillary transsphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model. Laryngoscope 110:286291, 2000 Sabit I, Schaefer SD, Couldwell WT: Extradural extranasal combined transmaxillary transsphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model. Laryngoscope 110:286–291, 2000

    • Search Google Scholar
    • Export Citation
  • 73.

    Schloffer H: Erfolgreiche Operation eines Hypophysentumors auf nasalem Wege. Wien Klin Wchnschr 20:621624, 1907 Schloffer H: Erfolgreiche Operation eines Hypophysentumors auf nasalem Wege. Wien Klin Wchnschr 20:621–624, 1907

    • Search Google Scholar
    • Export Citation
  • 74.

    Schloffer H: Zur frage der Operationen an der Hypophyse. Beitr Klin Chir 50:767817, 1906 Schloffer H: Zur frage der Operationen an der Hypophyse. Beitr Klin Chir 50:767–817, 1906

    • Search Google Scholar
    • Export Citation
  • 75.

    Spencer WR, , Das K, & Nwagu C, et al: Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope. Laryngoscope 109:791794, 1999 Spencer WR, Das K, Nwagu C, et al: Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope. Laryngoscope 109:791–794, 1999

    • Search Google Scholar
    • Export Citation
  • 76.

    Steinmeier R, , Fahlbusch R, & Ganslandt O, et al: Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report. Neurosurgery 43:739747, 1998 Steinmeier R, Fahlbusch R, Ganslandt O, et al: Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report. Neurosurgery 43:739–747, 1998

    • Search Google Scholar
    • Export Citation
  • 77.

    von Eiselsberg A: The operative cure of acromegaly by removal of a hypophysial tumor. Ann Surg 48:781783, 1908 von Eiselsberg A: The operative cure of acromegaly by removal of a hypophysial tumor. Ann Surg 48:781–783, 1908

    • Search Google Scholar
    • Export Citation
  • 78.

    Welbourn RB: The evolution of transsphenoidal pituitary microsurgery. Surgery 100:11851190, 1986 Welbourn RB: The evolution of transsphenoidal pituitary microsurgery. Surgery 100:1185–1190, 1986

    • Search Google Scholar
    • Export Citation
  • 79.

    Wilson CB: A decade of pituitary microsurgery. The Herbert Olivecrona Lecture. J Neurosurg 61:814833, 1984 Wilson CB: A decade of pituitary microsurgery. The Herbert Olivecrona Lecture. J Neurosurg 61:814–833, 1984

    • Search Google Scholar
    • Export Citation
  • 80.

    Yaniv E, & Rappaport ZH: Endoscopic transseptal transsphenoidal surgery for pituitary tumors. Neurosurgery 40:944946, 1997 Yaniv E, Rappaport ZH: Endoscopic transseptal transsphenoidal surgery for pituitary tumors. Neurosurgery 40:944–946, 1997

    • Search Google Scholar
    • Export Citation
  • 81.

    Zervas NT: Reflections on the surgery of the pituitary. Clin Neurosurg 27:124132, 1980 Zervas NT: Reflections on the surgery of the pituitary. Clin Neurosurg 27:124–132, 1980

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1622 785 92
Full Text Views 580 108 16
PDF Downloads 298 57 4
EPUB Downloads 0 0 0