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J Neurol Surg B Skull Base
DOI: 10.1055/a-2620-3407
Original Article

Pituitary Stalk Lesion Sampling by Transsphenoidal Posterior Lobe Biopsy: A Case Series

Kyly Hiatt 
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Zachary A. Abecassis
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Jessica Eaton
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Thomas Hanks
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
2   School of Medicine, University of Washington, Seattle, Washington, United States
,
Spencer Raub
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
2   School of Medicine, University of Washington, Seattle, Washington, United States
,
Eliza Baird-Daniel
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Zirun Zhao
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Fatima El-Ghazali
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Dominic Nistal
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Aria Jamshidi
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Kaitlyn Hartl
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Dan Child
3   Department of Pathology, University of Washington School of Medicine, Seattle, Washington, United States
,
Amy Lee
4   Department of Neurological Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, United States
,
Randall Bly
5   Department of Otolaryngology/Head and Neck Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, United States
,
Manuel Ferreira Jr.
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Jacob Ruzevick
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Samuel Emerson
1   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
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Abstract

Objective

This study aims to assess the safety and efficacy of performing posterior lobe pituitary biopsy in patients with pituitary stalk lesions compared with direct stalk biopsy.

Design

We performed a single-institution retrospective review of four patients who underwent endoscopic transsphenoidal surgery of the posterior pituitary lobe for a lesion of the pituitary stalk without clear diagnosis, despite noninvasive workup.

Participants

Four patients with known pituitary stalk lesions who underwent posterior pituitary biopsy without tumor resection.

Main Outcome Measures

The main outcomes were postprocedural endocrine function across all axes compared with preoperative function, postprocedural morbidities, and ability to obtain an accurate histologic diagnosis from biopsy.

Results

A total of 100% (4/4) patients were histologically diagnosed based on tissue from transsphenoidal biopsy of the posterior lobe. There was no worsening of preoperative endocrine function. One patient experienced a cerebrospinal fluid leak. There were no other postoperative complications. None of the patients experienced worsening of vision attributable to biopsy.

Conclusion

Transsphenoidal posterior lobe biopsy has a low-risk profile and high diagnostic capacity in patients presenting with a lesion of the pituitary stalk of uncertain etiology.

Keywords

posterior lobe - biopsy - bright spot - ETSS - pituitary stalk lesion - neurohypophysis


Publication History

Received: 18 February 2025

Accepted: 22 May 2025

Accepted Manuscript online:
26 May 2025

Article published online:
16 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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