Surgical treatment of pituitary tumors in the elderly: clinical outcome and long-term follow-up.
Pituitary adenomas in the elderly represent an increasing proportion of pituitary tumors, making the surgical management of these patients of special importance. We therefore decided to review our experience with transsphenoidal surgery (TSS) in this age group, in order to better evaluate its efficacy, safety and outcome. A retrospective study was performed on 39 patients aged more than 70 years at the time of surgery (mean age 74.1 +/- 2.9 years) and with a minimum follow-up duration of 4 years at the time of the study. Thirty-one had a nonfunctioning pituitary adenoma, 5 had a GH-secreting adenoma and 3 a macroprolactinoma, respectively. The commonest presenting symptom was visual deterioration (60%), whereas hypopituitarism were present in 41% of patients. All patients underwent TSS without any major peri- and post-operative complications. Visual fields improved in 74% of patients. Post-operative radiotherapy was performed in 17 patients with partial surgical resection and/or persistent hormonal hypersecretion, whereas 22 patients with subtotal or total surgical resection were treated by surgery only. Long-term follow-up (mean 9.1 +/- 2.7 years) showed evidence for tumor regrowth in one irradiated (5.9%) and 3 non-irradiated patients (13.6%), respectively. A noticeable complication of radiotherapy was progressive hypopituitarism, which worsened or developed in 65% of patients. We conclude that TSS is safe and well tolerated even in elderly patients, with a low incidence of minor complications. The indications for post-operative radiotherapy in patients with incomplete tumor resection should be better defined.
Ferrante
Luigi
L
Department of Neurological Sciences, Neurosurgery 2, University of Rome La Sapienza, Rome, Italy.
Trillò
Giuseppe
G
Ramundo
Epimenio
E
Celli
Paolo
P
Jaffrain-Rea
Marie-Lise
ML
Salvati
Maurizio
M
Esposito
Vincenzo
V
Roperto
Raffaele
R
Osti
Mattia Falchetto
MF
Minniti
Giuseppe
G
D000236:Adenoma / Q000532:radiotherapy / Q000601:surgery*; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome