Development of pituitary adenoma treatment--a critical essay.

The history of pituitary adenoma treatment shows, as in medicine in general, a succession of movements and counter movements. A large number of surgical techniques was proposed, but only very few survived the selection process. This selection was influenced not only by the general development of surgical techniques that also by the introduction of effective medical treatments and the arrival of new diagnostic methodology. We witness today a new selection mechanism besides the quality of the results--the economic pressure. Its importance may even increase in future because of progressing limitations of medical budgets. We subdivide the history of pituitary adenoma treatment into three main periods: the early period from Sir Victor Horsley to Norman Dott; the period of the reintroduction of the transphenoidal approach initiated by Gérard Guiot to the introduction of bromocriptine, the first effective antisecretory drug; and the period of refinement of the individual treatment methods still going on today. We present this history not so much in a retrospective way, by enumerating the single technical variations of surgical procedures but rather by presenting the momentary situations, as witnessed by our predecessors by presenting short extracts of contemporary texts to characterize the thinking in the past.