Transsphenoidal Surgery for Pituitary Tumors

  • Kalmon D. Post


The transsphenoidal approach to the sella dates back to Schloffer,1 who in 1907 reported the decompression of a growth hormone (GH)-producing tumor via this route. He had modified the operation of Giordano2 by not resecting the frontal sinus or floor of the anterior fossa. Further modifications ensued, including a submucosal dissection,3 a sublabial incision,4 the use of a headlight,5 and image-intensified fluoroscopy.6 Hardy7–10 added the operating microscope and microsurgical techniques to the procedure, so that with minimal morbidity and mortality, both microadenomas and large tumors could be safely removed or decompressed while sparing the pituitary gland.


Pituitary Adenoma Pituitary Tumor Cavernous Sinus Transsphenoidal Surgery Normal Gland 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    H. Schloffer, Erfolgreiche Operation eines Hypophysecentumors auf nasalem Wege, Wien. Clin. Wochenschr. 20:621–624, 1907.Google Scholar
  2. 2.
    G. Giordano, Compendio Chir. Operat. Ital. 2:100, 1897 (quoted by G.J. Heuer, The surgical approach and the treatment of tumors and other lesions about the optic chiasm, Surg. Gynecol. Obstat 53:489–518, 1931).Google Scholar
  3. 3.
    T. Kocher, Die Verletzungen der Wirbelsäule zugleich als Beitrag zur Physiologie des menschlichen Ruckenmarks Mitt a.d., Grenzgeb. Med. Chir. 1:415–580, 1896.Google Scholar
  4. 4.
    A.E. Halstead, Remarks on the operative treatment of tumors of the hypophysis, Surg. Gynecol Obstet 10:494–502, 1910.Google Scholar
  5. 5.
    A.B. Kanavel, The removal of tumors of the pituitary body by an infranasal route: A proposed operation with a description of the technique, J. Am. Med. Assoc. 53:1704–1707, 1909.CrossRefGoogle Scholar
  6. 6.
    G. Guiot and B. Thibaut, L’extirpation des adenomes hypophysares par voie transsphenoidale, Neuro-Chirur. (Stuttgart) 1:133, 1959.Google Scholar
  7. 7.
    J. Hardy, Microsurgery Applied to Neurosurgery (M.D. Yasargil, ed.), pp. 180–193, Academic Press, New York, 1969.Google Scholar
  8. 8.
    J. Hardy, Transsphenoidal microsurgery of the normal and pathological pituitary, Clin. Neurosurg. 16:185–217, 1969.PubMedGoogle Scholar
  9. 9.
    J. Hardy, Transsphenoidal hypophysectomy, J. Neurosurg. 34:581, 1971.Google Scholar
  10. 10.
    J. Hardy, Transsphenoidal microsurgical removal of pituitary adenoma, in: Recent Progress in Neurological Surgery, p. 86, Excerpta Medica, Amsterdam, 1974.Google Scholar
  11. 11.
    M. Arslan, Ultrasonic hypophysectomy in acromegaly: Report of 41 cases, Otol. Rhinol. Laryngol. 35:134–140, 1973.Google Scholar
  12. 12.
    J.N. Cross, K.W.M. Grossart, R.J. Kellett, J.A. Thomson, A. Glynn, W.B. Jannett, J.H. Lazarus, and M.H.C. Webster, Treatment of acromegaly by cryosurgery, Lancet 1:215–216, 1972.PubMedCrossRefGoogle Scholar
  13. 13.
    S.J. Richards, J.P. Thomas, and D. Kilby, Transethmoidal hypophysectomy for pituitary tumours, Proc. R. Soc. Med. 67:889–892, 1974.PubMedGoogle Scholar
  14. 14.
    M.V. DiTullio, Jr., and R.W. Rand, Efficacy of cryohypophysectomy in the treatment of acromegaly, J. Neurosurg. 46(1):1–11, 1977.PubMedCrossRefGoogle Scholar
  15. 15.
    W.F. Collins, Jr., Transsphenoidal surgery of pituitary adenomas, in: The Pituitary: A Current Review (M.B. Allen, Jr., and V.B. Mahesh, eds.), pp. 431–442, Academic Press, New York, San Francisco, and London, 1977.Google Scholar
  16. 16.
    G.H. Bateman, Transsphenoidal hypophysectomy: A review of 70 cases treated in the past two years, Trans. Am. Acad. Ophthalmol Otolaryngol. 63:103–110, 1962.Google Scholar
  17. 17.
    L.W. Conway, F.T. O’Fogludha, and W.F. Collins, Stereotactic treatment of acromegaly, J. Neurol. Neurosurg. Psychiatry 32:48–59, 1969.PubMedCrossRefGoogle Scholar
  18. 18.
    W.F. Collins, Hypophysectomy: Historical and personal perspective, in: Clinical Neurosurgery: Proceedings of the Congress of Neurological Surgeons (R.H. Wilkins, ed.), pp. 68–78, Williams & Wilkins, Baltimore, 1974.Google Scholar
  19. 19.
    N.T. Zervas and H. Hamlin. Stereotaxic thermal pituitary ablation, Acta Neurochir. 21(Suppl.):165–168, 1974.Google Scholar
  20. 20.
    C.B. Wilson, Personal communication.Google Scholar
  21. 21.
    G.T. Tindall, W.F. Collins, and J.A. Kirchner, Unilateral septal technique for transsphenoidal microsurgical approach to the sella turcica: Technical note, J. Neurosurg. 49:138, 1978.PubMedCrossRefGoogle Scholar
  22. 22.
    W.F. Collins, Personal communication.Google Scholar
  23. 23.
    K.D. Post and B.M. Stein, Spinal drainage catheter: Technical note, Neurosurgery 4(3):255, 1979.PubMedGoogle Scholar
  24. 24.
    J. Hardy, P.R. Townsend, and D.G. Cerundolo, Forces applied by nasal speculums during transsphenoidal operations, Surg. Neurol. 10:361, 1978.PubMedGoogle Scholar
  25. 25.
    J. Hardy, Transsphenoidal surgery of hypersecreting pituitary tumors, in: Diagnosis and Treatment of Pituitary Tumore (P.O. Kohler and G.T. Ross, eds.), pp. 179–194, Excerpta Medica, Amsterdam, 1973.Google Scholar
  26. 26.
    G. Guiot, Transsphenoidal approach in surgical treatment of pituitary adenomas: General principles and indications in non-functioning adenomas, in: Diagnosis and Treatment of Pituitary Tumors (P.O. Kohler and G.T. Ross, eds.), pp. 159–178, Excerpta Medica, Amsterdam, 1973.Google Scholar
  27. 27.
    L.S. Adelman and K.D. Post, Intraoperative frozen section technique for pituitary adenomas, Am. J. Surg. Pathol. 3(2):173–175, 1979.PubMedCrossRefGoogle Scholar
  28. 28.
    S. Saglam, C.L. Kragt, C.B. Wilson, S.L. Kaplan, and M. Barker, Graded cryohypophysectomy in the rhesus monkey: Histopathology and endocrine function, J. Neurosurg. 36:169–177, 1972.PubMedCrossRefGoogle Scholar
  29. 29.
    J.M. Van Buren and D.M. Bergenstal, An evaluation of graded hypophysectomy in man, Cancer 13:155–171, 1960.CrossRefGoogle Scholar
  30. 30.
    C.A. Hamberger, G. Hammer, G. Norien, et al., Transantrosphenoidal hypophysectomy, Arch. Otolaryngol. 74:2–8, 1961.PubMedCrossRefGoogle Scholar
  31. 31.
    W.H. Renn, and A.L. Rhoton, Jr., Microsurgical anatomy of the sellar region, J. Neurosurg. 43:288–298, 1975.PubMedCrossRefGoogle Scholar
  32. 32.
    G. Hammer and C. Radberg, The sphenoidal sinus: An anatomical and roentgenologic study with reference to transsphenoidal hypophysectomy, Acta Radiol 56:401–422, 1961.PubMedCrossRefGoogle Scholar
  33. 33.
    J. Kinnman, Surgical aspects of the anatomy of the sphenoidal sinuses and the sella turcica, J. Anat. 124(3):541–553, 1977.PubMedGoogle Scholar
  34. 34.
    R.M. Bergland, B.S. Ray, and M. Torack, Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases, J. Neurosurg. 28:93–99, 1968.PubMedCrossRefGoogle Scholar
  35. 35.
    E.R. Laws, J.C. Trautman, and R.W. Hollenhorst, Transsphenoidal decompression of the optic nerve and chiasm: Visual results in 62 patients, J. Neurosurg. 46:717–722, 1977.PubMedCrossRefGoogle Scholar
  36. 36.
    K.D. Post, B.J. Biller, L.S. Adelman, M.E. Molitch, S.M. Wolpert, and S. Reichlin, Results of selective transsphenoidal adenomectomy in women with galactorrhea—amenorrhea, J. Am. Med. Assoc. 242(2):158–162.Google Scholar
  37. 37.
    M.O. Thorner, A.S. McNeilly, C. Hagan, and G.M. Besser, Long-term treatment of galactorrhea and hypogonadism with bromocriptine, Br. Med. J. 2:419–422, 1974.PubMedCrossRefGoogle Scholar
  38. 38.
    E. Del Pozo, L. Varga, H. Wyss, G. Tolis, H. Friesen, R. Wenner, L. Vetter, and A. Euttwiler, Clinical and hormonal response to bromocriptine (CB-154) in the galactorrhea syndromes, J. Clin. Endocrinol. Metab. 39:18–26, 1974.PubMedCrossRefGoogle Scholar
  39. 39.
    Editorial, Pituitary tumors and pregnancy, Lancet 1:404, 1976.Google Scholar
  40. 40.
    P.B. Nelson, A.G. Robinson, D.F. Archer, and J.C. Maroon, Symptomatic pituitary tumor enlargement after induced pregnancy, Presented at the American Association of Neurological Surgeons Annual Meeting, New Orleans, Louisiana, April 1978.Google Scholar
  41. 41.
    R.J. Chang, W.R. Keye, Jr., J.R. Young, C.B. Wilson, and R.B. Jaffe, Detection, evaluation, and treatment of pituitary microadenomas in patients with galactorrhea and amenorrhea, Am. J. Obstet. Gynecol. 128:356–4363, 1977.PubMedGoogle Scholar
  42. 42.
    J. Hardy, Transsphenoidal microsurgical treatment of hypersecreting pituitary adenomas, Presented at the American College of Physicians, Neuroendocrine Course, Montreal, Canada, March 1978.Google Scholar
  43. 43.
    G.T. Tindall, C. Scott, C.S. McLanahan, and J.H. Christy, Transsphenoidal microsurgery for pituitary tumors associated with hyperprolactinemia, J. Neurosurg. 48:849–860, 1978.PubMedCrossRefGoogle Scholar
  44. 44.
    W.F. Collins, Jr., Transsphenoidal surgery of pituitary adenomas, in: The Pituitary (M.B. Allen, Jr., and V.B. Mahesh, eds.), pp. 431–442, Academic Press, New York, 1977.Google Scholar
  45. 45.
    C.B. Wilson and L.C. Dempsey, Transsphenoidal microsurgical removal of 250 pituitary adenomas, J. Neurosurg. 48:13–22, 1978.PubMedCrossRefGoogle Scholar
  46. 46.
    A.M. Schnall, J.S. Brodkey, B. Kaufman, and O.H. Pearson, Pituitary function after removal of pituitary microadenomas in Cushing’s disease, J. Clin. Endocrinol. Metab. 47(2):410–417, 1978.PubMedCrossRefGoogle Scholar
  47. 47.
    J.B. Tyrell, R.M. Brooks, P.A. Fitzgerald, P.B. Cofoid, P.H. Forsham, and C.B. Wilson, Cushing’s disease: Selective transsphenoidal resection of pituitary microadenomas, N. Engl. J. Med. 298(14):753–758, 1978.CrossRefGoogle Scholar
  48. 48.
    R.M. Salassa, E.R. Laws, Jr., P.C. Carpenter, and R.C. Northcutt, Transsphenoidal removal of pituitary microadenoma in Cushing’s disease, Mayo Clin. Proc. 53:24–28, 1978.PubMedGoogle Scholar
  49. 49.
    J. Hardy, Recent advances in the diagnosis and treatment of pituitary tumors, International Symposium held in San Francisco, California, May 31-June 4, 1978.Google Scholar
  50. 50.
    R.M. Salassa, T.P. Kearns, J.W. Kernohan, R.G. Sprague, and C.S. MacCarty, Pituitary tumors in patients with Cushing’s syndrome, J. Clin. Endocrinol. Metab. 19:1523–1539, 1959.PubMedCrossRefGoogle Scholar
  51. 51.
    J. Garcia-Uria, J.M. del Pozo, and G. Bravo, Functional treatment of acromegaly by transsphenoidal microsurgery, J. Neurosurg. 49:36–40, 1978.PubMedCrossRefGoogle Scholar
  52. 52.
    M.A. Giovanelli, E.D.F. Motti, A. Paracchi, P. Beck-Peccoz, B. Ambrosi, and G. Faglia, Treatment of acromegaly by transsphenoidal microsurgery, J. Neurosurg. 44:677–686, 1976.PubMedCrossRefGoogle Scholar
  53. 53.
    H. Sang, U. CB. Wilson, and J.B. Tyrrell, Transsphenoidal microhypophysectomy in acromegaly, J. Neurosurg. 47:840, 1977.CrossRefGoogle Scholar
  54. 54.
    E.R. Laws, Jr., The neurosurgical management of acromegaly: Results in 82 patients treated between 1972 and 1977, Presented at the AANS Annual Meeting in April 1978 (Paper No. 33).Google Scholar
  55. 55.
    J. Hardy, M. Somma, and J.L. Vezina, Treatment of acromegaly: Radiation or surgery?, in: Current Controversies in Neurosurgery (T.P. Morley, ed.), pp. 377–391, W.B. Saunders, Philadelphia, 1976.Google Scholar
  56. 56.
    H. Cushing, Intracranial tumors, in: Notes upon a Series of Two Thousand Verified Cases with Surgical-Mortality Percentages Pertaining Thereto, p. 150, Charles C. Thomas, Springfield, Illinois, 1932.Google Scholar
  57. 57.
    O. Hirsch, Pituitary tumours: A borderland between cranial and trans-sphenoidal surgery, N. Engl. J. Med. 254:937–939, 1954.CrossRefGoogle Scholar
  58. 58.
    E.R. Laws, Jr., and E.B. Kern, Complications of trans-sphenoidal surgery, Clin. Neurosurg. 23(Chapt. 29):401–416, 1975.Google Scholar
  59. 59.
    C.S. McLanahan, J.H. Christy, and G.T. Tindall, Anterior pituitary function before and after trans-sphenoidal microsurgical resection of pituitary tumors, Neurosurgery 3(2): 142–145, 1978.CrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1980

Authors and Affiliations

  • Kalmon D. Post
    • 1
  1. 1.Department of Neurosurgery, Tufts-New England Medical Center HospitalTufts University School of MedicineBostonUSA

Personalised recommendations