Gigantum humeris insidentes: Modern pituitary surgery as developed through the contribution of a giant

摘要

The article by Pendleton et al. could be added to the large series of articles that in the past few years have shed light on one of the more dynamic fields of the modern neurosur-gery, ie, the pituitary surgery. As a matter of fact, it is a well-balanced and thoughtful article that points out, through the surgical deeds of a giant, namely Dr. Cushing, the continuous evolution of this kind of surgery with an unbiased and open mind. It provides a true analytical, rather than merely historical perspective, on the kaleidoscope of surgical routes to access the sellar region. Indeed, we found very interesting the original case series with peer-detailed description of outcomes in terms of surgical results, complications, morbidity, and mortality and, furthermore, the comparison among the different techniques. It is remarkable that since the early experience the transsphenoidal approach resulted in a greater rate of patients discharged in "well/improved conditions" as compared with the transcranial option (64% vs 0%). Although a quite greater mortality rate was addressed for the transsphenoidal series, the authors definitely highlighted how Cushing improved this drawback, thanks to the learning curve, technological advances, and/or environment improvement.