Interest in pituitary surgery began in 1893 when Caton and Paul operated on an acromegalic patient via a temporal approach; the tumor was never reached and the patient subsequently died. Between 1904 and 1906, Horsley operated on 10 patients using a combination of subfrontal and middle cranial fossa approaches with a 20% mortality rate. A transfacial approach via transglabellar incision with excision of the frontal sinuses and the superior nose was described in 1897. This laid the framework for Schloffer in 1907 to perform the first transsphenoidal approach via a superior rhinectomy incision. In 1909, Kocher added resection of the septum submucosally; while Kanavel described an inferior nasal approach reflecting the external nose superiorly. In 1910, Hirsch described his classic endonasal transseptal approach. Hirsch’s approach avoided a lateral rhinotomy incision but his visualization was limited by the diameter of the external nares. Finally, in 1910, Halstead added a sublabial incision to Hirsch’s transseptal approach. This avoided external scarring while improving the breadth of the operative field. Cushing, utilizing a combination of these transsphenoidal techniques between 1910 and 1925, had a mortality rate of 5.6% in 231 cases. With morbidity usually from infection, Cushing began developing and using more transcranial approaches in order to reduce infectious complications, and by 1931, he had abandoned the transsphenoidal approach. This resulted in a dominance of frontal approaches for pituitary tumors during the 1930s to 1960s [2, 4, 7].