Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas

• Published in: Journal of neurosurgery Vol. 123; no. 1; pp. 31 - 38
• Main Authors: Gondim, Jackson A, Almeida, João Paulo, de Albuquerque, Lucas Alverne F, Gomes, Erika, Schops, Michele, Mota, Jose Italo
• Format: Journal Article
• Language: English
• Published: United States 01-07-2015
• Subjects: Adenoma - surgery; Adult; Age Factors; Aged; Aged, 80 and over; Endoscopy - methods; Female; Humans; Incidence; Male; Middle Aged; Neurosurgical Procedures - methods; Pituitary Neoplasms - surgery; Postoperative Complications - epidemiology; Retrospective Studies; Sphenoid Sinus - surgery; Treatment Outcome; PRL = prolactin; PA = pituitary adenoma; TSH = thyroid-stimulating hormone; ACTH = adrenocorticotropic hormone; elderly; pituitary adenomas; pituitary surgery; GH = growth hormone; endoscopy; ASA = American Society of Anesthesiologists; transsphenoidal; SIADH = syndrome of inappropriate antidiuretic hormone
• ISSN: 0022-3085; 1933-0693
• DOI: 10.3171/2014.10.JNS14372

With the increase in the average life expectancy, medical care of elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little information exists in the literature about the surgical treatment of these patients. The aim of this study was to present the results of a single pituitary center in the surgical treatment of PAs in patients > 70 years of age.
In this retrospective study, 55 consecutive elderly patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The clinical and radiological results in this group were compared with 2 groups of younger patients: < 60 years (n = 289) and 60-69 years old (n = 30).
Fifty-five patients ≥ 70 years of age (average age 72.5 years, range 70-84 years) underwent endoscopic surgery for treatment of PAs. The mean follow-up period was 50 months (range 12-144 months). The most common symptoms were visual impairment in 38 (69%) patients, headache in 16 (29%) patients, and complete ophthalmoplegia in 6 (10.9%). Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower frequency of pituitary apoplexy before surgery (p < 0.05). Tumors with cavernous sinus invasion were treated surgically less frequently than in younger patients. Although patients with an American Society of Anesthesiologists score of 3 were more common in the elderly group (p < 0.05), no significant difference regarding surgical time, extent of resection, and hospitalization were observed. Elderly patients presented with more complications than patients < 60 years (32.7% vs 10%, p < 0.05). Complications observed in the elderly group included 5 CSF leaks (9%), 2 permanent diabetes insipidus cases (3.6%), 4 postoperative refractory hypertension cases (7.2%), 1 myocardial ischemia (1.8%), and 1 death (1.8%). Postoperative new anterior pituitary deficit was more common in the younger group (< 60 years old: 17.7%) than in the elderly (≥ 70 years old: 12.7%); however, there was no statistical difference.
Endoscopic transsphenoidal surgery for elderly patients with PAs may be associated with higher complication rates, especially secondary to early transitory complications, when compared with surgery performed in younger patients. Although the worst preoperative clinical status might be observed in this group, age alone is not associated with a worst final prognosis after endoscopic removal of nonfunctioning PAs.