Biopsy Results And Clinical Characteristics Of 142 Patients With Indistinguishable Sellar Lesions

Objective To summarize the etiology spectrum and clinical characteristics of patients with sellar lesions that are difficult to diagnose through noninvasive examination,to explore the clinical value,safety and indications of biopsy by endoscopic transsphenoidal approach,and to improve the recognition,diagnosis and treatment of these diseases.Methods The clinical data of 142 patients with sellar lesions that are difficult to diagnose through noninvasive examination who underwent endoscopic transsphenoidal biopsy at the neurosurgery department of Peking Union Medical College Hospital from 2011 to 2019 were retrospectively analyzed.Through literature review,the clinical characteristics of these diseases,the safety and indications of biopsy were overviewed.Results The etiology of such diseases can be divided into cystic diseases,inflammatory/infectious diseases,and tumor diseases.The most common among cystic diseases are Rathke’s cleft cysts.The most common among inflammatory/infectious diseases are Langerhans cell histiocytosis and lymphocytic hypophysitis,and the most common among tumor diseases are germ cell tumors.Patients with tumor diseases were significantly younger than those of the other two at the time of biopsy.The clinical features lack obvious specificity among the three types of diseases.Of the 142 patients in this group,biopsy by endoscopic transsphenoidal approach was performed for 115 patients,and biopsy by endoscopic extended transsphenoidal approach was performed for 27 patients.7 patients had central nervous system infections in one month after the surgery,and 3 had cerebrospinal fluid leakage,of which 2 patients were surgically repaired.The incidences were basically the same as those of classic surgery.Conclusions The clinical characteristics of this type of disease lack specificity frequently.Noninvasive examination is difficult for identifying the causes of this type of disease.Histopathological examination is the gold standard for diagnosis.Endoscopic transsphenoidal biopsy in the sellar region is relatively safe and reliable.It can be used to diagnose and guide the treatment.