Surgery for Elderly Patients with Nonfunctional Pituitary Adenomas Appears to Be Safe

Pituitary adenomas account for 10-25% of primary intracranial neoplasms, and their incidence increases with older age. The risk of surgery may be higher in elderly patients. We aimed to compare the safety and efficacy of endoscopic transsphenoidal surgery for nonfunctional adenomas (NFPAs) between elderly and younger patients.

We retrospectively reviewed the consecutive patients undergoing primary endoscopic transsphenoidal surgery of NFPA at the Helsinki University Hospital during 2011-2020. We classified patients into 2 groups: elderly (≥70 years) and younger (<70 years) patients. We evaluated patients preoperatively and postoperatively.

A total of 226 patients were included. Fifty-five (24%) of them were elderly with median age of 72 years (interquartile range 71-76), and 171 were younger with median age of 58 years (interquartile range 47-64). There were no differences in the maximal diameter of adenomas between elderly and younger patients (median 27 mm vs. 23 mm), but elderly more often had preoperative visual field deficits (72% vs. 51%, P = 0.007). Postoperative 3-month magnetic resonance imaging revealed residual tumor in 58% of elderly and 56% of younger patients (P = 0.98). There was no significant difference in the incidence of postoperative complications between the groups (elderly: 31% vs. younger: 36%). However, postoperative pneumonia more often occurred among elderly. Twenty-six (81%) elderly and 79 (90%) younger patients with preoperative visual field deficits improved postoperatively (P = 0.13).

Endoscopic transsphenoidal surgery for selected elderly patients with NFPAs appears to be safe and effective, suggesting that surgical decisions should be guided by individual risk profiles rather than age alone.