Safety of endoscopic endonasal biopsy for the pituitary stalk-hypothalamic lesions.

PURPOSE: The indications for and the optimal biopsy approach in pituitary stalk-hypothalamic (PsH) lesions are controversial. Biopsies through an endoscopic endonasal approach (EEA) for PsH lesions have often been considered to cause the infundibulo-tuberal syndrome. The purpose of this study was to analyze the surgical and endocrinological safety of EEA biopsies for PsH lesions.

METHODS

A total of 39 consecutive patients who underwent an EEA biopsy between June 2011 and August 2020 in a single institute were retrospectively analyzed. The ophthalmological and endocrinological outcomes were assessed before and after surgery.

RESULTS

PsH lesions were confirmed to be diverse pathological diagnoses, ranging from lymphocytic hypophysitis to diffuse midline glioma, and the most common pathologic diagnosis was a germinoma (18 patients, 46.2%). No patients developed visual deterioration after the biopsy. In patients without preoperative panhypopituitarism, 13 out of 28 patients (46.4%) developed new anterior pituitary hormonal deficiencies after the biopsy. When the tissue was collected from the stalk, the endocrinological deterioration rate was 100% (6 of 6 patients), while the rate was 31.8% (7 of 22 patients) when tissue could be harvested from an extra-stalk lesion. The rate of newly developed permanent diabetes insipidus after surgery was 40.9% (9 of 22 patients). The median surgery time was 125 min, and there was no postoperative CSF leakage or infections noted.

CONCLUSIONS

An EEA biopsy for PsH lesions is a safe and efficient surgical method unless the tissue is collected from the stalk.