History of pituitary surgery from the technical aspect

Transcranial and trans-sphenoidal pituitary surgery were developed independently with few exceptions by different groups of surgeons. The transcranial approaches, primarily the transfrontal-parasagittal and the frontotemporal along the sphenoid ridge, evolved without many variations within a short time span. The trans-sphenoidal exposures of the pituitary, on the contrary, underwent many modifications provoked by the fear of postoperative meningitis and the search for improved vision through the narrow alley leading to the target. Only Guiot in 1978 ended the extensive discussion by convincingly demonstrating that well-defined indications existed for each procedure. Improvement of diagnostic and surgical tools was a major factor for refining the surgical technique and improving the surgical results.