Pituitary Surgery from the Pioneers to Recent Technological Innovations: What are the Key Challenges of 21st Century Surgery of the Sella Turcica?

Over the past two decades, surgical approaches to the sella turcica have evolved significantly, particularly with the adoption of endoscopic transsphenoidal techniques. Despite these advancements, several challenges persist, including anatomical variability, age-related morphological changes, management of large pituitary adenomas, postoperative complications, and technological limitations. This perspective article discusses these key challenges, drawing upon recent literature to highlight areas requiring ongoing research and innovation.