gms | German Medical Science

Objective: Lesions associated with a thickened pituitary stalk have a diverse pathology. For clinical diagnose, it is necessary to make a diagnosis based on pathological biopsy of the lesions. The objectives of this study were to review endoscopic biopsies of the lesions and to assess the Multidisciplinary Collaboration for management of these lesions.

Method: 12 patients (7 males and 5 females) aged from 8 to 38 years underwent endoscopic biopsy of a pituitary stalk lesion between 2010 and 2012 at PUMCH (Peiking Union Medical College Hospital). The relationships of the extent of lesions with surgical approaches were retrospectively examined.

Results: Among the 12 patients, a biopsy was performed via an endoscopic transsphenoidal approach for 7 with pituitary stalk associated with intrasellar lesions; via an endoscopic extended transsphenoidal approach for 4 with pituitary stalk localized lesions; and via an endoscopic intraventricular approach for 1 with the lesion protruding from the infundibulum. Pathological examinations of all the lesions confirmed diagnoses of germinoma in 10 patients, Langerhans cell histiocytosis in 2 patients. None of the 12 patients had further deterioration of pituitary function postoperatively.

Conclusions: Endoscopic biopsy of pituitary stalk lesions is a microinvasive way compared to transcranial biopsy. The endoscopic transsphenoidal approach is most suitable for biopsies of pituitary stalk lesions associated with intrasellar lesions. Otherwise, the endoscopic intraventricular approach seems suitable for intraventricular lesions , and the endoscopic extended transsphenoidal approach appears appropriate for localized pituitary stalk lesions.