Late Career and Legacy
The introduction of the transsphenoidal approach into neurosurgical practice was a monumental step for the treatment of pituitary lesions. What began as a concept studied on cadavers was brought into the limelight with the successful surgery conducted by Hermann Schloffer. His bold attempt at accessing the pituitary through an extracranial approach represented the academic attitudes of the time, where experimental procedures, often revolutionary in their conceptualization, were being conducted with the hope of improving patient mortality rates that were considered well above an acceptable range. In 1911, 4 years after his inaugural transsphenoidal surgery and following the traditional route of academic surgeons at the time, Hermann Schloffer returned to the prestigious University of Prague as a professor of surgery. Throughout the rest of his career, Schloffer continued to make significant impacts in the field of surgery. As Schloffer was specialized in both neurological and abdominal surgery, he also pioneered numerous abdominal procedures. His most notable contribution in this regard included a 3-phase resection of the large intestine for complicated diverticulitis and rectal carcinomas. He also coined the terms "Schloffer tumor" and "Schloffer broth," the first referring to a rare pseudotumor resulting from chronic granulomatous inflammation secondary to scarring from abdominal surgeries and the latter referring to a urine agar used for the cultivation of Corynebacterium diptheriae.
In addition to his academic contributions to the field of surgery, Schloffer was also an active member in Austrian high society, receiving extensive recognition in that regard. In 1913, Schloffer became a full member of the Society for the Support of German Arts, Research, and Literature. He also served as an honorable member of the Society of Physicians in Vienna and as a member of the Correspondents of Medical Societies in Innsbruck and Budapest. However, the greatest honor Schloffer received was the third-class medal of the Order of Emperor Franz Josef I. Despite tumultuous geopolitical upheavals, societal changes, and global war, Hermann Schloffer spent the rest of his career in Prague as a professor of surgery. He died on January 21, 1937, at the age of 68. In recognition of Schloffer's contributions, his legacy is still honored by the Charles University of Prague to this day. Visitation to his tomb (number 55 at the Olšanské cemetery) remains part of the walking tour and is offered by the Cabinet of the History of Medicine at Charles University in Prague to students, faculty, and the public on a regular basis.
Being the first surgeon to successfully perform transsphenoidal surgery on a living patient was the greatest of Hermann Schloffer's academic contributions to neurosurgery. Despite the limitations of his procedure, it was groundbreaking in that it provided a foundation for other surgeons experimenting with alternative extracranial approaches to the pituitary. Even after undergoing multiple transformations and a brief fall into obscurity, the transsphenoidal approach introduced by Schloffer has proven itself through generations of surgeons and now remains the standard approach for lesions of the sella turcica. Although there is no way Schloffer could have foreseen the full impact his transsphenoidal procedure would have over time, he clearly recognized its tremendous potential as an alternative route to accessing the skull base. While the approach itself has radically changed to incorporate new technologies and improvements in clinical and aesthetic outcomes, the fundamental concept has remained the same, and echoes of Schloffer's bold attempt at reaching the pituitary through the sphenoid sinus still resonate in operating rooms to this day.