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Cushing's legacy to transsphenoidal surgery

Journal of Neurosurgery

|April 1, 1981

Summary

Harvey Cushing initially favored the transsphenoidal approach for pituitary adenomas, later preferring transfrontal surgery for broader access. His work influenced the resurgence of transsphenoidal surgery.

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Area of Science:

Neurosurgery
Endocrinology
Ophthalmology

Background:

Review of Harvey Cushing's surgical techniques for pituitary adenomas and chiasmal syndrome.
Analysis of Cushing's shift from transsphenoidal to transfrontal surgical routes.

Discussion:

Cushing's preference for transfrontal surgery was due to its ability to access the pituitary and verify suprasellar tumors.
Cushing utilized the transsphenoidal route preferentially for large sellas until 1929.

Key Insights:

Cushing's rejection of transsphenoidal surgery was not due to dissatisfaction but the advantages of the transfrontal approach.
Norman Dott's positive experience with transsphenoidal surgery influenced Gérard Guiot, contributing to its modern prominence.

Outlook:

The historical evolution of surgical approaches for pituitary and suprasellar lesions.
The enduring legacy of surgical pioneers in neurosurgery and the development of minimally invasive techniques.

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