THE CONTRIBUTION OF GIORDANO,DAVIDE (1864-1954) TO PITUITARY SURGERY - THE TRANSGLABELLAR-NASAL APPROACH

THIS REPORT DESCRIBES the fundamental contribution made by Davide Gior dano, proposing the transglabellar surgical approach in a period in wh ich transfacial and transbasal operative approaches to the pituitary g land were considered inadvisable because of their risk. His idea was t o gain access through bilateral paranasal and frontal skin incisions, allowing removal of the ethmoid bone and the anterior wall of the sphe noidal cube. With the anterior and inferior aspects of the sella turci ca thus exposed, bone is removed and the gland is exposed by incision of the dura mater. The technique proposed by giordano is undoubtedly a forerunner of the transsphenoidal route to the pituitary gland. The i mportance of his contribution was confirmed by Gushing, who reported h is first use of the approach of Giordano in 1909 in a patient with a p ituitary adenoma. The efforts of Giordano clearly inspired surgeons of his era to perform this operation clinically, giving impetus to the f urther development of neurosurgery.