Minimally invasive pituitary surgery

Since its original description in 1907, surgery of the pituitary gland has undergone a remarkable evolution. While open transsphenoidal approaches gained an early following, they were mostly abandoned in favor of craniotomy because of concern of inadequate tumor resection. However, with widespread use of antibiotics in the 1950s and the introduction of the surgical microscope in the 1960s, the transsphenoidal approach gained popularity as the procedure of choice in the management of pituitary neoplasms. Widespread application of endoscopic surgery for diseases of the sinuses in the 1980s and 1990s, including the management of skull base tumors and cerebrospinal fluid leaks, led to the development of the technique of minimally invasive pituitary surgery (MIPS). MIPS has gained in popularity because of the remarkable visualization provided by the endoscope in addition to the reduced morbidity and rapid recovery afforded by this minimally invasive technique.