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September 1967

Transethmosphenoidal Hypophysectomy

Author Affiliations

Bristol, England
From the Department of Otolaryngology, University of Bristol, United Bristol Hospitals, England.

Arch Otolaryngol. 1967;86(3):256-264. doi:10.1001/archotol.1967.00760050258004

IT IS NOW 14 years since the first total hypophysectomies were performed by Luft and Olivecrona by the transfrontal route. The operation was only rendered possible when cortisone became available for replacement therapy. It was not long after this that total hypophysectomy was also undertaken by various transsphenoidal routes, and the destruction of the gland was also attempted by the implantation of radioactive gold (198Au) and later by yttrium (90Y).

For many years, controversy has raged over the advantages and disadvantages of the various surgical routes and irradiation techniques. After studying the various alternative techniques, I was satisfied that the transethmosphenoidal would prove the most successful in my hands for the following reasons.

Transfrontal Approach.—Transfrontal craniotomy is an operation of considerable magnitude, with an operative mortality of 12% and a risk of ocular and olfactory nerve palsies. It is not possible to see into the depth of the sella, nor

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