Endoscopic extended transsphenoidal approach in the biopsy of pituitary stalk occupying lesions

Abstract

Background Pituitary stalk occupation can result from various lesions, therefore the diagnosis is difficult to a certain extent. The clinical significance of the biopsy to pituitary stalk occupying lesions on suprasellar region remains controversal. Objective To analyze the value and safety of pituitarys talk biopsy by endoscopic extended transsphenoidal approach in the diagnosis of pituitary stalk occupying lesions. Methods and Results There were 16 patients who received pituitary stalk biopsy by endoscopic extended transsphenoidal approach from 2011 to 2017, and reconstruction of sellar floor was done by bath-plug technique and pedicled nasoseptal flap. Postoperative pathological examination identified germinoma in 10 cases, Langerhans' cell histiocytosis (LCH) in 3 cases, lymphocytic hypophysitis in 2 cases and craniopharyngioma in one case. After operation, 2 patients had central nervous system (CNS) rhinorrhea, while no patient had new hypopituitarism, damage of visual field and eyesight, cerebrospinal fluid (CSF) rhinorrhea, unplanned secondary surgery, death or other serious complications. Conclusions Pituitary stalk biopsy by endoscopic extended transsphenoidal approach is a safe and reliable surgical method which is instructive for patient's diagnosis and treatment plan. It is worth popularizing widely.

DOI: 10.3969/j.issn.1672-6731.2019.03.007