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Transcraniad surgery for pituitary adenomas Evolution of pituitary surgery 010
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The first actually recorded
surgical intervention for a pituitary tumor can be traced
back to Frank Thomas Paul (1851–1941) in the year 1893. However, Sir Victor
Horsley (1857–1916) was probably the first surgeon, who operated on a pituitary
adenoma dating back to the year 1889. It is known, that he used a bifrontal
craniotomy. In order to reach the sella region he described a technique of
‘‘cerebral dislocation’’. However, he encountered a cystic lesion, that he
described as not inoperable [20]. Because of this experience and Horsley‘s
former laboratory work on sheeps, Frank Thomas Paul eventually consulted Sir
Horsley about a case of a young woman with acromegaly.
Horsley eventually
recommended
a subtemporal approach. Paul’s pioneering transcranial procedure ended with
intractable brain swelling and the consecutive death of the patient eight hours
later. Another pioneer of transcranial surgery considering pituitary tumors,
Otto Theobald Tiliani in New York, started gathering experience with a
bifrontal intradural approach on cadavers in 1903. Almost at the same time
Fedor Victor Krause (1857–1937), a surgeon in Berlin, Germany, tried to remove
a shot gun bullet from the area of the right optic foramen in a patient who had
attempted suicide, by an extradural right frontal approach (Fig. 1). Encouraged
by the good outcome of this patient, it was Fedor Krause, who performed the
first recorded successful resection of a pituitary tumor utilizing an
extradural transfrontal approach avoiding extensive retraction of the frontal
lobe in 1905 [19].
The mortality
rates of transcranial surgery regarding the pituitary region ranged between 50%
and 80% in these days. Between 1904 and 1906 Sir Victor Horsley went on
approaching pituitary lesions by transcranial procedures and finally operated a
consecutive series of 10 patients with pituitary tumors utilizing both,
subfrontal and subtemporal approaches with an improved mortality rate of about
20%.
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