Surgery for elderly patients with non-functional pituitary adenomas is as appears to be safe as surgery for younger patients.

Abstract

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 non-functional 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 two groups: elderly (≥70 years) and younger (<70 years) patients. We evaluated patients pre- and postoperatively. A total of 226 patients were included. Fifty-five (24%) of them were elderly with median age of 72 years (interquartile range [IQR] 71-76) and 171 were younger with median age of 58 years (IQR 47-64). There were no differences in the maximal diameter of adenomas between elderly and younger patients (median 27mm vs 23mm), but elderly more often had preoperative visual field deficits (72% vs 51%, p=0.007). Postoperative 3-month MRI 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.