Minimally invasive surgical approaches to the sphenoid sinus, sella, parasellar and clival region: current and future perspectives.

Since its original description in 1907, surgery of the pituitary gland has undergone a remarkable evolution. While open transphenoid approaches gained interest, they were mostly abandoned in favour of craniotomy because of concern of inadequate tumour resection. However, with widespread use of antibiotics in the 1950s and introduction of surgical microscope in the 1960s, the transphenoidal 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 tumours and CSF leaks, led to the development of the technique of minimally invasive pituitary surgery. Endoscopic endonasal pituitary surgery 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 technique. Now it is almost routine at many centres to extend transnasal endoscopic-assisted surgery beyond the sinuses to the orbit and skull base. Providing excellent intranasal visualization, endoscopes are now used to perform frontal sinus drainage procedures, to repair CSF leaks, for orbital and optic nerve decompression and to perform dacryocystorhinostomies.