Outcomes of the Transsphenoidal Approach for Pituitary Adenomas in Elderly Patients

Background: As average life expectancy increases, census data projects one in every 5 people in the United States will be considered elderly by 2030. Approximately 7% of pituitary tumors occur in patients greater than 65 years old. Endocrine dysfunction, visual deficits and neurologic dysfunction due to pituitary adenomas can lead to rapid deterioration in this population. However, neurosurgeons are generally reluctant to operate on the elderly due to medical comorbidities. In this study, we aim to evaluate the safety and efficacy of transsphenoidal endoscopic endonasal resection for pituitary adenomas in the elderly population.

Methods: We retrospectively analyzed 130 consecutive patients who underwent transsphenoidal endoscopic endonasal resection for pituitary adenomas at the University of Miami Hospital between 2012 and 2016. We collected data including demographics, tumor characteristics, surgical technique and postoperative course. Univariate and multivariate regression analyses were performed assessing differences in morbidity and mortality in the elderly versus adult population.

Results: Of the 130 patients, 23 patients were over the age of 70 (18%) and 9 patients were over the age of 80 (7%). There were no significant differences in the rate of surgical and endocrinological cure between the patients ages 70 and over from those 69-years-old and younger. Postoperative complication rates were similar between the two groups including rate of permanent diabetes insipidus (4.3% elderly and 12.1% adult), cerebrospinal fluid leak (8.7% elderly and 8.4% adult), and meningitis (4.3% elderly and 2.8% adult). There were no deaths in our cohort.

Conclusion: While all surgical procedures must be carefully optimized in elderly patients, the transsphenoidal endoscopic endonasal approach can be safe and effective for resection of pituitary adenomas even in the elderly population.