Medical Corner: Otolaryngology Pioneers of Transsphenoidal Surgery
This month the PNA Medical Corner focuses on an article co-authored by Dr. Edward Laws, a longtime member of the PNA. The research looks at the considerable impact two early otolaryngologists, Markus Hajek and Oskar Hirsch, had in developing endonasal transsphenoidal pituitary surgery.
Laryngoscope 2022 Nov 24.
doi: 10.1002/lary.30496. Online ahead of print.
Hajek and Hirsch: Otolaryngology Pioneers of Endonasal Transsphenoidal Pituitary Surgery
Objective: To evaluate the historical descriptive origins of the extracranial transnasal transsphenoidal route to the sphenoid sinus and sella turcica focusing on the works of two otolaryngologists: Markus Hajek (1861-1941) and Oskar Hirsch (1877-1965).
Data sources: A collection of primary references of author publications, and contemporary references and textbooks.
Review methods: Primary references were reviewed with specific focus on surgical routes to the sphenoid sinus and sella turcica. Chronology was cross-referenced with contemporary publications by contemporaries. Translations from German were conducted by author AM when necessary.
Results: Markus Hajek elegantly described the surgical approach to the posterior ethmoids and sphenoid sinus in 1904 using a transnasal route. Building on this foundation, Oskar Hirsch described the fully extracranial endonasal transethmoid transsphenoidal approach in 1909. He was first to describe surgical entrance to the sella using this exclusively unilateral endonasal route, which he demonstrated on a cadaver. He reports performing this procedure on a live patient in April, 1910, under local anesthesia in stages over 5 weeks. For better exposure, Hirsch consolidated his method with Killian’s submucosal window resection of the posterior nasal septum allowing for bilateral access to the sphenoid sinus and sella, and completed a single stage procedure on a patient in June 1910.
Conclusion: Oskar Hirsch was the first to describe and perform a stepwise surgical approach to the sella using an exclusively extracranial, endonasal, transethmoid, and transsphenoidal approach. He built upon his mentor Markus Hajek’s approaches to the posterior ethmoid cells and sphenoid sinus.
Level of evidence: N/A: Background information, synthesis from multiple sources emphasizing factual information Laryngoscope, 2022.
Keywords: endonasal approach; historical; hypophyseal tumor; sella turcica.
© 2022 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.
1. Horsley V. Address in surgery delivered at the seventy-fourth annual meeting of the British Medical Association, on the technique of operations on the central nervous system. Br Med J. 1906;2:411-423.
2. Kiliani OG. II. Some remarks on tumors of the chiasm, with a proposal how to reach the same by operation. Ann Surg. 1904;40:35-43.
3. Krause F. Hirnchirurgie [brain surgery]. Dtsch Klin. 1905;8:953-1024.
4. Schloffer H. Zur frage der Operationen an der Hypophyse. Beitr Klin Chir. 1906;50:767-817.
5. Kocher T. Ein fall von hypophysis-tumor mit operativer heilung. Deutsche Zeitschrift für Chirurgie. 1909;100:13-37.
Dr. Edward Laws