Although pituitary surgery via the transsphenoidal approach has been performed for over a century, it has only gained widespread acceptance over the past 50 years. As various advances in illumination and magnifcation through microscopic and endoscopic approaches have improved the safety and effcacy of this technique, it has become the workhorse approach for surgery on the pituitary gland. Further advances, including better understanding of pituitary adenoma biology and improved reconstruction techniques, have extended the utility of this approach to treatment of pathology beyond the sella turcica and its contents. We review the history of pituitary surgery with an emphasis on advances with the transsphenoidal approach.