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World Neurosurg. 2017 Oct;106:315-321. doi: 10.1016/j.wneu.2017.06.151. Epub 2017 Jul 1.

Risks and Benefits of Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas in Patients of the Ninth Decade.

Author information

1
Universitatea de Medicină Şi Farmacie Tîrgu Mures, Tîrgu Mureş, Romania; Clinica de Neurochirurgie, Spitalul Clinic Judeţean de Urgenţă Tîrgu Mureş, Tîrgu Mureş, Romania.
2
Service de Neurochirurgie B, Chirurgie de la base du Crâne et de l'hypophyse, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Inserm U1052, CNRS UMR5286, « Signaling, metabolism and tumor progression » Centre anti-cancéreux, Lyon, France.
3
Fédération d'endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.
4
Université Claude Bernard Lyon I, Lyon, France.
5
Centre de pathologie et de biologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon I, Lyon, France.
6
Inserm U1052, CNRS UMR5286, « Signaling, metabolism and tumor progression » Centre anti-cancéreux, Lyon, France; Fédération d'endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon I, Lyon, France.
7
Service de Neurochirurgie B, Chirurgie de la base du Crâne et de l'hypophyse, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Inserm U1052, CNRS UMR5286, « Signaling, metabolism and tumor progression » Centre anti-cancéreux, Lyon, France; Université Claude Bernard Lyon I, Lyon, France. Electronic address: emmanuel.jouanneau@chu-lyon.fr.

Abstract

BACKGROUND:

The population older than 80 years of age (very elderly) is increasing, and the management of these patients with pituitary surgery is controversial.

OBJECTIVE:

To determine the prevalence of pituitary tumors in elderly patients and to determine the safety of endoscopic transsphenoidal pituitary surgery for nonfunctioning pituitary adenomas in patients aged older than 80 years.

METHODS:

This retrospective study included elderly (65-75 years old) and very elderly consecutive patients operated between 2007 and 2015 for nonfunctioning pituitary adenomas. Tumor characteristics, comorbidities, pre- and postoperative visual and endocrinologic status, and postoperative complications were compared.

RESULTS:

Of the total 623 operated patients, 307 had nonfunctioning pituitary adenomas. Twenty-three percent (n = 143) of all patients were aged older than 65 years, whereas 2.56% (n = 16) were aged older than 80 years. Gonadotroph and nonimmunoreactive tumors occurred in 81% of patients aged older than 65 years. The study groups were Group A, comprising 15 patients aged older than 80 years, and Group B, comprising 49 patients aged 65-75 years. No presurgical statistical differences were noted between the 2 groups. Complete tumor resection was achieved in 53.3% of Group A and 73.5% of Group B. Postsurgical visual status improved significantly in Group A than in Group B (P = 0.0012). No deaths occurred, and no group differences were noted in the postoperative complications.

CONCLUSIONS:

Age exceeding 80 years is not by itself a predictor of worse clinical outcome of endoscopic transsphenoidal pituitary surgery for nonfunctioning adenomas. Emphasis should be placed on visual pathway decompression for the quality of life in very old people.

KEYWORDS:

Elderly; Nonfunctioning pituitary adenoma; Skull base surgery; Transsphenoidal endoscopic surgery

PMID:
28676462
DOI:
10.1016/j.wneu.2017.06.151
[Indexed for MEDLINE]

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