Cushing's first case of transsphenoidal surgery: the launch of the pituitary surgery era

Transsphenoidal approaches to pituitary tumors have undergone a rigorous test of time since the introduction of the first technique by Schloffer in 1907. Harvey W. Cushing played an instrumental role in launching the era of pituitary surgery by popularizing the transsphenoidal route between 1909 and 1929. Cushing performed his first transsphenoidal operation in 1909 in a patient with acromegaly by using a modified form of the Schloffer method to reach the pituitary gland. He did not find this approach satisfactory and instead favored a modified form of the sublabial-transsphenoidal route described by A. E. Halstead and Theodor Kocher. At that time, the development of intracranial surgical corridors to the sellar region was in its infancy. Later in his career, in 1927, Cushing's mastery of intracranial surgery ultimately led him to favor the subfrontal or "transfrontal" route to treat pituitary tumors. In this article, the authors review the clinical details of Cushing's first case of transsphenoidal pituitary surgery.