Endonasal endoscopic pituitary surgery in the elderly.

Area of Science:

• Neurosurgery
• Endocrinology
• Geriatric Medicine

Background:

• Pituitary adenomas present risks through mass effect or hormone overproduction.
• Surgical decisions for elderly patients require careful consideration due to potentially increased complication risks.
• Limited data exists on endonasal endoscopic surgery outcomes in large elderly cohorts.

Purpose of the Study:

• To audit outcomes of endoscopic endonasal transsphenoidal resection of pituitary adenomas in elderly patients.
• To compare surgical outcomes in patients aged 60-69 versus 70+ years.
• To evaluate complication rates and extent of resection in older patient populations.

Main Methods:

• Retrospective review of a prospectively acquired database.
• Inclusion of patients aged 60 years and older undergoing endonasal endoscopic pituitary adenoma resection.
• Analysis of demographic, radiographic, and outcome data, including complications.

Main Results:

• 135 patients were analyzed (81 aged 60-69, 54 aged 70+).
• Tumor size was slightly larger in the 70+ group (25.7 mm vs. 23.1 mm).
• Complication rates were 7.4% in the 60-69 group and 18.5% in the 70+ group (p=0.05), with higher cranial complication rates in the older group (p=0.013).

Conclusions:

• Endonasal endoscopic surgery for pituitary adenomas is safe in elderly patients.
• A graded increase in complication rates is observed with advancing age.
• Clinical decisions for surgery in asymptomatic or mildly symptomatic elderly patients must account for age-related increases in surgical risks.