History of pituitary surgery

Introduction. We review the history of pituitary surgery from its beginnings in Ancient Egypt to the present day.

Methods. We performed a retrospective, observational review of publications related to the discovery of the pituitary gland as an organ and the evolution of surgical techniques targeting the gland, particularly since the 19th century.

Results. The first transnasal interventions described were performed in Ancient Egypt, as an embalming technique. Aristotle, Galen, and Vesalius described the existence of a “mucus-producing” intracranial gland, the pituitary. The first craniectomies and intracranial procedures were described between 1880 and 1890, and the first transsphenoidal surgery was performed in 1907. The gland’ s main hormonal functions were discovered between 1918 and 1944. From 1929 to 1950, transfrontal approaches were used in pituitary surgery. From 1950, the transsphenoidal technique returned, with antibiotics and corticosteroids also being used to reduce rates of surgical complications, enabling gradual advances and eventually the introduction of the neurosurgical microscope. Endoscopic transsphenoidal surgery was first used in 1994. From 1994 to 2020, endoscopic endonasal surgery has been the technique of choice in pituitary surgery.

Discussion. The late 19th century was a key period in the understanding of the pituitary gland and in the development of neurosurgery. In the 20th century, the transfrontal and transsphenoidal approaches used in the early days of pituitary surgery led the way to the perfection of the surgical technique, culminating with today’s endoscopic endonasal surgery. The combination of physiological and surgical understanding of the structure has enabled more precise diagnosis and safer, more effective treatment of patients with pituitary disorders.

Transsellar surgery, endoscopic endonasal surgery, transsphenoidal surgery, pituitary, history of the pituitary gland