Skull base surgery: past, present, and future trends

Abstract

<jats:p>The author outlines the history of skull base surgery and describes the new paradigm emerging with increasing use of endoscopic microneurosurgery.</jats:p>

The evolution of extracranial approaches to the pituitary and anterior skull base

“…Harvey Cushing's mentor, Theodor Kocher (1841-1917), modified Schloffer's approach by removing the septum submucosally to allow for better visualization, however it wasn't until 1910, when Oskar Hirsch (1877-1965) developed a completely endonasal transseptal transsphenoidal operation, based upon his mentor, Hajek's treatment for sphenoid sinusitis [5,13,[21][22][23][24][25]. This approach completely avoided that disfiguring lateral rhinotomy.…”

“…The first reported successful resection of a pituitary tumor by the transsphenoidal approach was by Hermann Schloffer (1868-1937) of Austria in 1907 [24,25]. Anatomic studies done by the Italian surgeon Davide Giordano [1,13,23,24] led to Schloffer's development of a transfacial transsphenoidal approach.…”

“…Guiot was impressed with the simplicity and neatness of the transsphenoidal operation. He published a series of more than 1000 cases of transsphenoidal operations in the late 1950s [22,24,25]. Guiot refined his technique through the use of intraoperative radiofluoroscopy and preoperative angiograms.…”

“…Using the assistance of a headlight, Cushing was able to perform his operation under direct vision throughout the entire approach. He began using a headlight routinely during his operations and later a lighted speculum, which allowed for better visualization throughout the procedure [5,24,25]. From 1910 to 1925, Cushing operated on 231 pituitary tumors using the sublabial transsphenoidal approach with a mortality rate of only 5.6% [25] (Fig.…”

“…A pediatric surgeon trained in the treatment of complex facial defects, such as cleft palate repair, Dott continued to use the transsphenoidal approach and over the years designed special instruments for this procedure. Specifically, he designed a speculum with a lighted tip which allowed him superior visualization during the procedure [13,21,22,25,30].…”