Endonasal Endoscope-Assisted Microscopic Approach

Transsphenoidal surgery was first described a century ago by, among others, Schloffer, Cushing and Hirsch. In the 1950s and 1960s, Dott, Guiot and Hardy began using the sublabial transsphenoidal route for removal of pituitary adenomas. With the advent of the operating microscope and the technique of selective adenomectomy as described by Hardy in the early 1970s, transsphenoidal surgery emerged into the modern microsurgical era. Additional experience in the 1970s and early 1980s by Wilson, Weiss, Laws, and others, further improved the safety and efficacy of transsphenoidal surgery. Subsequent modifications were developed to minimize mucosal trauma and patient discomfort associated with the sublabial approach, most notable of which was the direct endonasal approach first described by Griffith and Veerapan in 1987 and later by Cooke and Jones in 1994. This approach, which requires minimal posterior nasal mucosal dissection and no turbinate removal, is now commonly used with the operating microscope and often with endoscopic assistance.