hypophysectomy [Neurosurgery Wiki]

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In 1910, [[Oskar Hirsh]], an otolaryngologist, introduced a transseptal, transsphenoidal approach to the pituitary gland
((Hirsch O. Endonasal method of removal of hypophyseal tumors: With a report of two successful cases. JAMA. 1910;55:772–774.))
an operation which is still in use today. Cushing performed his first pituitary operation in 1909 
((Cushing H. Partial hypophysectomy for acromegaly: With remarks on function of the hypophysis. Ann Surg. 1909;50:1002–1017.))
using Schloffer's method but then rapidly adopted Hirsh's approach adding a sublabial incision and a headlamp to improve visualization of the sella. Using this approach he performed 231 operations with a 5.6% mortality rate 
((Cushing H. The Weir Mitchell Lecture: Surgical experiences with pituitary disorders. JAMA. 1914;63:1515–1525.))
((Maroon JC. Skull base surgery: past, present, and future trends. Neurosurg Focus. 2005 Jul;19(1):E1.)).

Hirsch continued to perform transphenoidal [[hypophysectomy]] and by 1937 had performed the operation on 277 patients with a mortality rate of 5.4%
((Senior BA, Ebert CS, Kolln K, Bassim MK, Younes M, Sigounas DG, et al. Minimally invasive pituitary surgery. Laryngoscope. in press.)).
After being displaced from Austria by the Nazis shortly thereafter, he emigrated to the US and continued to operate at Massachusetts General Hospital in collaboration with a neurosurgeon, [[Hannibal Hamlin]]. The other surgeon who kept the technique alive was Norman Dott, a British neurosurgeon who learned the approach in 1923 from Cushing and by 1956 had performed 80 procedures with no deaths 
((Maroon JC. Skull base surgery: past, present, and future trends. Neurosurg Focus. 2005 Jul;19(1):E1.)).

The modern advent of the transsphenoidal approach as the preferred approach to the pituitary began in 1956 when a French neurosurgeon, Gerard Guiot, learned the technique from Dott and brought it back to Paris and reintroduced it to skeptical colleagues. He ultimately performed over 1,000 transsphenoidal hypophysectomies and also introduced the use of intraoperative fluoroscopy
((Maroon JC. Skull base surgery: past, present, and future trends. Neurosurg Focus. 2005 Jul;19(1):E1.))
((Liu JK, Das K, Weiss MH, Laws ER, Jr, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg. 2001 Dec;95(6):1083–1096.))
((Landolt AM. History of pituitary surgery from the technical aspect. Neurosurg Clin N Am. 2001 Jan;12(1):37–44.)).
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Total hypophysectomy it is a classical procedure that currently has many indications especially in patients with [[Cushing syndrome]] without good endocrine control. [[Extended endoscopic transsphenoidal approach]]es grant us an alternative standpoint to the classic transsphenoidal microscopic approach and a comprehensive assessment of the process.

Cárdenas Ruiz-Valdepeñas et al., provides technical nuances and describe step by step the radical endoscopic hypophysectomy. The study of cadaveric specimens adds clarifying dissections.

Radical hypophysectomy is an easily replicable and safe procedure. The most important morbidity is the intraoperative [[cerebrospinal fluid leakage]], which is inherent to this technique and can be successfully prevented with a pedicled nasoseptal flap reconstruction
((Cárdenas Ruiz-Valdepeñas E, Kaen A, Perez Prat G. Endoscopic radical
hypophysectomy: how I do it. Acta Neurochir (Wien). 2016 Nov;158(11):2159-2162.
PubMed PMID: 27638642.
)).