Simple SummaryThis paper provides a definition of the sella, a description of common pathologies affecting the region, and an overview of the historical development of surgical approaches, as well as the advantages of techniques that are commonly used today.AbstractThe sellar and parasellar region can be affected by diverse pathologies. The deep-seated location and surrounding critical neurovascular structures make treatment challenging; there is no singular, optimal approach for management. The history and development of transcranial and transsphenoidal approaches by pioneers in skull base surgery were largely aimed at treating pituitary adenomas, which are the most common lesions of the sella. This review explores the history of sellar surgery, the most commonly used approaches today, and future considerations for surgery of the sellar/parasellar region.