title: Transsphenoidal pituitary surgery in the elderly is safe and effective.
abstract: OBJECTIVE
  With an increasingly ageing population, the number of elderly people diagnosed with pituitary tumours continues to rise. There is a concern that with increasing age and comorbidities, there is higher anaesthetic risk, as well as peri-operative morbidity and mortality from pituitary surgery. This study aimed to audit the benefits and complications of transsphenoidal surgery performed in a large pituitary centre in elderly patients.
  
  
  METHODS
  Data on all elderly patients (age: ≥ 70 years) undergoing transsphenoidal surgery at a large tertiary referral centre between November 2003 and August 2012 were collected retrospectively.
  
  
  RESULTS
  A total of 104 operations were performed on 102 patients during 106 months. Median age was 75.2 years (range: 70-94) and 63 (61%) of the patients were male. Median follow-up was 15.2 months (range: 2.3-84.4). The majority presented with either peripheral visual field defects (26.4%) or pituitary hormone deficits (17.9%). A significant number (21.7%) of tumours were incidental radiological findings while investigating other diagnoses like stroke and dementia. 48.1% of operations were undertaken microscopically and the remaining 51.9% were endoscopic. Median hospital stay was 4 days (range: 3-18). Intra-operative complications included hypotension (1.9%) and blood loss requiring transfusion (2.9%). The 30-day complications included transient diabetes insipidus (9.6%), syndrome of inappropriate anti-diuretic hormone secretion (8.7%), delayed cerebrospinal fluid leak requiring lumbar drainage (0.9%) with no patient requiring formal repair. There were no peri-operative deaths. Long-term assessment suggested 79% had improved or stable endocrine function with 7% achieving biochemical cure and 91% showed improved or stable visual fields.
  
  
  CONCLUSIONS
  Pituitary surgery in the elderly, whether microscopic or endoscopic, has low morbidity and mortality and is a safe and effective intervention for both symptom control and functional outcomes.
authors.affiliation: Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals , Oxford , UK.
authors.forename: Erlick A C
authors.initials: EA
authors.lastname: Pereira
authors.forename: Puneet
authors.initials: P
authors.lastname: Plaha
authors.forename: Aswin
authors.initials: A
authors.lastname: Chari
authors.forename: Menaka
authors.initials: M
authors.lastname: Paranathala
authors.forename: Nicholas
authors.initials: N
authors.lastname: Haslam
authors.forename: Angela
authors.initials: A
authors.lastname: Rogers
authors.forename: Tim
authors.initials: T
authors.lastname: Korevaar
authors.forename: Diane
authors.initials: D
authors.lastname: Tran
authors.forename: Remi
authors.initials: R
authors.lastname: Olarinde
authors.forename: Niki
authors.initials: N
authors.lastname: Karavitaki
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Grossman
authors.forename: Simon A
authors.initials: SA
authors.lastname: Cudlip
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010907:Pituitary Hormones / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010907:Pituitary Hormones
keywords: adenoma; elderly; endoscopic; outcomes; pituitary; transsphenoidal adenohypophysectomy; tumour