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Safety of endoscopic endonasal biopsy for the pituitary stalk-hypothalamic lesions



The indications for and the optimal biopsy approach in pituitary stalk-hypothalamic (PsH) lesions are controversial. Biopsies through an endoscopic endonasal approach (EEA) for PsH lesions have often been considered to cause the infundibulo-tuberal syndrome. The purpose of this study was to analyze the surgical and endocrinological safety of EEA biopsies for PsH lesions.


A total of 39 consecutive patients who underwent an EEA biopsy between June 2011 and August 2020 in a single institute were retrospectively analyzed. The ophthalmological and endocrinological outcomes were assessed before and after surgery.


PsH lesions were confirmed to be diverse pathological diagnoses, ranging from lymphocytic hypophysitis to diffuse midline glioma, and the most common pathologic diagnosis was a germinoma (18 patients, 46.2%). No patients developed visual deterioration after the biopsy. In patients without preoperative panhypopituitarism, 13 out of 28 patients (46.4%) developed new anterior pituitary hormonal deficiencies after the biopsy. When the tissue was collected from the stalk, the endocrinological deterioration rate was 100% (6 of 6 patients), while the rate was 31.8% (7 of 22 patients) when tissue could be harvested from an extra-stalk lesion. The rate of newly developed permanent diabetes insipidus after surgery was 40.9% (9 of 22 patients). The median surgery time was 125 min, and there was no postoperative CSF leakage or infections noted.


An EEA biopsy for PsH lesions is a safe and efficient surgical method unless the tissue is collected from the stalk.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.


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This study is supported and funded by Seoul National University Hospital (Grant No. 0520200030, to Y. H. Kim).

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Authors and Affiliations



Conceptualization: YHK; Methodology: HK, JHK, YHK; Formal analysis and investigation: HK, K-MK; Writing-original draft preparation: HK; Writing-review and editing: M-SK, JHK, YHK, C-KP; Funding acquisition: YHK; Supervision: C-KP, JHK, YHK.

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Correspondence to Yong Hwy Kim.

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The authors have no relevant financial or non-financial interests to disclose.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the principles of the Declaration of Helsinki 1964 and its later amendments or comparable ethical standards. Approval was granted by the Institutional Review Board of authors’ institutions (No. 1910-127-1072).

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The requirement for written informed consent was waived because of the retrospective design of this study by the Institutional Review Board of Seoul National University Hospital.

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Kang, H., Kim, KM., Kim, MS. et al. Safety of endoscopic endonasal biopsy for the pituitary stalk-hypothalamic lesions. Pituitary 25, 143–151 (2022).

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  • Stalk lesion
  • Hypothalamic lesion
  • Endoscopic endonasal surgery
  • Endoscopic endonasal biopsy