The transsphenoidal approach to the pituitary using the microscope has undergone continuous modification since its introduction by Hardy over 50 years ago. It is one of the most effective and safest of major neurosurgical procedures with excellent outcomes and low complication rates.Although being displaced by the endoscopic approach, it remains the 'gold standard' for a number of pituitary conditions such as Cushing's tumours, and for the majority of the remainder, has yet to be overtaken in outcome results by the endoscopic approach.This description of the endonasal 'septal pushover' technique is from an author with experience in nearly 4,000 cases. The anatomy is described, and the step-by-step approach and tumour removal for micro- and pituitary macroadenomas are given. Complications and their avoidance are overviewed.
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