The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk

Abstract

In western countries, the process of "ageing of the population" is increasingly forcing clinical medicine to find answers for pathologies affecting the elder segments of our community. In this respect, pituitary adenomas often raise difficult questions on surgical indications, since little is known about postoperative morbidity and mortality in elderly patients. The transsphenoidal endonasal approach (TNS), which is considered the gold standard for surgical resection of the majority of functioning and non-functioning pituitary adenomas, is supposed to be a low morbidity and mortality procedure in adult patients. However, only a few contradicting data are available in the literature about elderly patients. In this paper we retrospectively analyze a cohort of 43 consecutive patients aged more than 65years, operated on for pituitary adenomas at our Institution in the years 1998-2007. These patients were treated by transsphenoidal endonasal approach (TNS) for resection of non-functioning pituitary adenomas (n=31), GH-secreting adenomas (n=4) and ACTH-secreting adenomas (n=8). Clinical records reported a macroadenoma with tumour-related mass symptoms in about 80% of patients; single or multiple pituitary deficits were present in 44% of patients. Regarding comorbidities, cardiac disease was the most frequently observed (86%); assessment of anaesthesiological risk indicated a moderate to severe ASA score in most patients, 11% showing a 4-5 score. On the basis of current criteria, our retrospective analysis revealed that cure was achieved in 54% of patients. The outcome was similar to that observed in the general population of patients undergoing transphenoidal surgery in our centre, without differences in the rate of surgical and endocrinological cure, minor and major surgical complications and hospitalization duration. In particular, no significant anaesthesiological complications were observed and no patient developed either permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. In conclusion, in specialized centres the surgical treatment of pituitary adenomas via the transsphenoidal route can be a safe and effective procedure even in elderly patients.