Professor Carl-Axel Hamberger delivered his Semon Lecture in 1962, a lecture titled “Transantrosphenoidal Hypophysectomy”. His speech started with a background describing that the transantrosphenoidal approach had been the matter of much discussion. The two chief objections raised to this procedure had been the risk of infection, and the poor exposure considered to be provided by the operative field. However, Professor Hamberger delivered several arguments in favour of the transantrosphenoidal route; 1. The risk of infection was regarded to have decreased greatly due to the use of chemotherapeutics and antibiotics. 2. An approach through the maxillary sinus did give excellent exposure: thus judgement as to whether extirpation was complete was possible. This was probably the most important consideration, since in most cases complete enucleation was essential for bringing about the desired effect. 3. All manipulations of the optic chiasm and optic nerves could be avoided, and thus visual damage ruled out. 4. Certain complications, which were apt to follow all intracranial operations of this magnitude, could be eliminated. Among them were postoperative extradural haematoma, brain damage, and postoperative cerebral oedema, possibly with the later appearance of epilepsy.
Professor Hamberger continued by describing the case material, in all 163 transantrosphenoidal operations, on which his experience was based. He talked about the presurgical investigation by X-ray and the surgical approach. A thorough description of the anatomical variations of the sphenoid sinus, depending upon the extent to which the sphenoid bone is pneumatized, was shown. Likewise he described the importance of the thickness of the anterior wall of the sella turcica. He stated that considering that the dominant indication for hypophysectomy was metastatic mammary cancer, 86 of his 163 cases, it should be kept in mind that the anatomical relations were anomalous and the thickness of the anterior wall and floor of the sella turcica was not uniform in many cases of metastatic spread to the sphenoid bone. The various surgical steps of the transantrosphenoidal hypophysectomy approach were meticulously described and similarly the postoperative treatment.
Then followed a section concerning the complications. Of particular interest he discussed hemorrhage, leakage of cerebrospinal fluid, and infection. In Professor Hamberger´s hands however, the bleeding was usually very slight, and leakage of cerebrospinal fluid only occasionally observed. Meningitis, the most dreaded complication, had occurred in a few of his early cases, but of no greater magnitude than after any neurosurgical intervention.
Professor Hamberger ended his much appreciated lecture by stating that according to his opinion, the transantrosphenoidal approach should be the major route for hypophysectomy in order to obtain good results for the patients with few complications. – Sten Hellstöm