Abstract
INTRODUCTION: Pituitary adenomas constitute about 10-15% of all intracranial tumors. Manifestations are varying from hormonal disturbances to mass effect from compression of the surrounding structures of the skull base to pituitary apoplexy. Surgical management can be achieved via trans-cranial approach or endonasal approaches. HISTORICAL PERSPECTIVE: In 1907 Schloffer performed the first pituitary surgery via lateral rhinotomy. This was followed by submucosal resection of septum and endonasal approach then sublabial trans-septal corridor and after that Sublabial Trans-septal Trans-sphenoidal approach. In 1970, the trans-sphenoidal approach has become the preferred approach for pituitary adenomas either sublabial or transnasal. These two approaches were the standard corridor for many years. The development of endoscope allowed its use in such surgeries. At first it was used at the end of the microscopic surgeries to explore residual tumors or blind angles then was used and reported in 1992 by Jankowski et al. who performed endoscopic transnasal transsphenoidal approach, then microscope. This can be termed endoscopic assisted microsurgery. In 1996 Jho et al. described entirely endoscopic transnasal transsphenoidal approach. It was pure endoscopic surgery. Like the new era of new term of micro-neurosurgery, for the last two decades the Endo-neurosurgery is evolving very rapidly. CONCLUSION: In comparison to surgical microscope better magnification, illumination and close up view provided by the endoscopes has helped in precise delineation of the tumor and has ensured completeness of tumor removal. Extensive knowledge of endoscopic anatomy and training is mandatory starting from observation in operating room, Cadaveric lab., Neurosimulation and finally clinical practice.