Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly

Abstract

Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM) operated by the endoscopic endonasal approach (EEA). Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

“…Regarding procedural circumstances, increasing surgeon experience was positively associated with postoperative visual field deficit improvement in three studies (early groups: 75–86%; late groups: 90–100%) [ 5 , 8 , 9 ]. Furthermore, extend of resection was associated with poor visual field deficit outcomes in one study (p = 0.01), while three studies found no significant relation, both for visual acuity and visual field deficit outcomes [ 22 , 36 , 40 , 42 ].…”

“…Mean age per study ranged between 35.5 and 72.5 years (median: 50) and the percentage female patients ranged between 15 and 100% (median: 45%). Seven studies included only non-functioning pituitary adenoma patients [ 28 , 31 , 33 , 37 , 40 , 42 , 46 ]. Gross total resection grades were reported in 26 studies and ranged between 14 and 91% (median: 63.5%) (Table 1 ) [ 5 , 6 , 8 , 11 , 20 , 21 , 24 – 26 , 28 – 34 , 36 – 40 , 42 , 43 , 46 , 47 ].…”

“…In studies that did not specify type of visual problems, 17–100% of the patients presented with visual problems (Supplementary Table 3) [ 31 , 39 ]. Unspecified outcomes of visual improvement were reported in 13 studies [ 24 , 26 , 31 – 35 , 38 – 40 , 43 , 45 , 47 ]. Pooled prevalence for complete recovery was 32.9% (95% CI: 28.5–37.7%, I 2 : 84.2%, n = 139/416).…”

“…The majority of studies (83.3%) had a high risk of bias due to suboptimal methodology or poor reporting (Table 3 ). While all studies clearly described the surgical approach (exposure of intervention), only one study scored all points for selection and description of included patients and only one study for the description, interpretation, and discussion of the outcomes (outcome assessment) [ 31 , 40 ]. However, study quality was associated with visual outcomes in a meta-regression (all p < 0.05).…”

Endonasal endoscopic pituitary surgery in the elderly

“…In contrast to our results and those of Gondim et al, the analysis of Zhan et al showed equivalent complication rates in both groups (6.3% in the elderly group and 5.7% in the younger group; both groups had 7 cranial complications each [6 CSF leaks and 1 postoperative hematoma], and the older group had 3 cases of meningitis compared with 2 cases in the younger group; p = 0.85). Marenco et al 25 reported on 25 patients aged 65 years or older who underwent a total of 28 endoscopic procedures for nonfunctioning pituitary adenomas, but the authors did not provide any data for younger patients managed at their center. There was one perioperative death in their series (3.6% of 28 procedures), and complications were identified in 8 (32%) of the 25 patients.…”