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.