gms | German Medical Science

Objective: The historical contributions to transsphenoidal pituitary surgery from the United States particularly of Cushing are well known due to the careful work up of his operated patients by his pupils and recent historical papers published by American neurosurgeons. However less is known about the contributions to transsphenoidal pituitary surgery from Europe in particular from Germany, Austria and Switzerland.

Method: The presentation is based on the evaluation of the original articles of Austrian, Swiss and German surgeons and laryngologists published in the first two decades of the 20^th century.

Results: The craddle for transsphenoidal pituitary surgery became Vienna. The presuppositions were here in the first decade of the 20^th century very prosperous. A detailed topographical work on the paranasal sinuses was elaborated by the Anatomist Emil Zuckerkandl. The diagnostic possibilities with the the founder of the Neuroradiology Artur Schüller and the recognized ophthalmologist Ernst Fuchs were very favourable. In Innsbruck Ernst Schloffer performed the first transsphenoidal pituitary operation by lateral rhinotomy removing most of the intranasal bone structures in March 1907. 3 month later Anton von Eiselsberg performed in Vienna the same type of operation. With over 30 procedures von Eiselsberg had the greatest experience with this type of surgery. Julius von Hochenegg performed 1908 in Vienna the first three operations for acromegaly by the endonasal route. The operative technique was improved 1909 by Theodor Kocher in Bern Switzerland. A minimally invasive transsphenoidal approach was developed in Vienna by the laryngologist Oskar Hirsch. He used from 1910 on a transseptal transsphenoidal approach. He performed over 500 operations by this approach. The Viennese laryngologist Ottokar von Chiari developed the shortest access to the sellar region extraxially along the orbito nasal rim through the ethmoid and the sphenoid sinus which was later prefererred by many ENT surgeons.

Conclusions: In Germany most of the surgeons followed Fedor Krause and preferred a transcranial approach to the sellar region. The laryngologists in Germany were focused on inferior tranpalatal and transpharyngeal accesses to reach the sphenoid sinus and the sella turcica, which finally had not obtained general acceptance.