How should biopsy/resection of a pituitary stalk lesion be performed?
- The TSS approach to resection/biopsy of a pituitary stalk lesion should only be performed by an experienced neurosurgeon.
- Depending on the suspected pathology, the neurosurgical approach might include a planned gross total resection, a subtotal/decompressive surgery, or biopsy alone.
- Complete resection of a presumed inflammatory lesion/hypophysitis should be avoided because surgery is unlikely to be curative and may be associated with increased endocrine and neurosurgical risks.
- Specifically, with pituitary stalk lesion resection, there is an increased risk of central DI, CSF leak, and hypopituitarism. Lastly, there is ≈ 10% risk of a negative/nondiagnostic biopsy result.
- In cases of suspected pituitary stalk neoplasms in adults (e.g., pituicytoma, spindle cell oncocytoma, craniopharyngioma, etc.), the risks and benefits of a gross total resection versus a subtotal resection followed by radiation therapy must be individually assessed.
- The goal is to control tumor growth and minimize mass effects while also preserving pituitary/hypothalamic function, whenever possible.
