Safety and Outcome of Transsphenoidal Pituitary Adenoma Resection in Elderly Patients

Pituitary adenomas account for 10%-20% of intracranial brain tumors but have greater incidence in elderly patients. We assessed microsurgical treatment for pituitary adenomas in this population.

A retrospective cohort of patients ≥60 years of age was identified. Patients were divided into deciles by age for evaluation of variables affecting outcome: 60-70 (group 1), 71-80 (group 2), and >80 years (group 3).

Two hundred five patients were identified among group 1 (n = 131), group 2 (n = 65), and group 3 (n = 9). Preoperative variables other than age did not differ. Most patients presented with visual disturbance, in 56.5%, 73.8%, and 50% in groups 1, 2, and 3, respectively. The next most common indication was headache, followed by endocrinopathy. Tumors were overwhelmingly nonfunctional (P = 0.97) and macroadenomas (P = 0.5) in all 3 groups. Gross total resection occurred in 56.9%-80% of patients, and this rate did not differ among groups. Complication rates of 6.9% in group 1, 9.2% in group 2, and 0.0% in group 3 were observed (P = 0.8). No perioperative mortality was identified. Mean length of follow-up ranged from 8.9 to 28.3 months.

In this series of microsurgical resection of pituitary adenomas in elderly patients, good efficacy and safety of treatment were observed. Preclusion of surgical treatment, including open resection, simply because of age is not warranted and instead a comprehensive evaluation of a patient's risk profile and surgical goals should be undertaken.