Pure Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Adenomas in the Elderly: Surgical Outcomes and Complications in 158 Patients.
OBJECTIVE
To evaluate the safety and efficacy of the endoscopic endonasal transsphenoidal approach (EETA) for nonfunctioning pituitary adenoma (NFPA) in the elderly population.


METHODS
We performed a retrospective review of operative cases over a 7-year period, in which 158 elderly patients (age 65 years and older) who underwent a pure EETA to remove a pituitary adenoma were identified and compared with a series of 155 younger patients (age 40-55 years) who underwent the same procedure during the same period. The medical charts of the patients were reviewed to collect demographic information, such as age, sex, clinical symptoms, tumor size, the extent of tumor resection, clinical outcome, and complications.


RESULTS
In the elderly group, total resection was achieved in 120 patients (75.9%), and 124 patients (78.5%) achieved significant postsurgical visual remission. In the younger group, total resection was achieved in 119 patients (76.8%), with 126 patients (81.2%) achieving significant postsurgical visual remission. Regarding surgical complications in the elderly group, transient diabetes insipidus occurred postoperatively in 28 (17.8%) patients, and permanent diabetes insipidus occurred in 7 (4.4%) patients. Six (6.4%) patients experienced postoperative cerebrospinal fluid leakage, and new developments of anterior hypopituitarism occurred in 15 (9.5%) cases. In the younger group, 21 (13.6%) patients developed transient diabetes insipidus postoperatively, and 5 (3.2%) patients experienced permanent diabetes insipidus. Six (3.9%) patients reported postoperative cerebrospinal fluid leaks, and 13 (8.4%) patients developed a new anterior hypopituitarism. There were no cases of either carotid artery injury or death in either group. During the follow-up (mean, 32 months), 11 (6.9%) patients experienced tumor recurrence in the elderly group compared with 24 (15.5%) patients in the younger group. Of the 15 elderly patients who developed new hypopituitarism, 13 (86.7%) recovered without hormone replacement; accordingly, the rate of hypopituitarism remission was 84.6% in the younger patients.


CONCLUSIONS
NFPAs in the elderly can be resected via a pure endoscopic technique with low morbidity and mortality.
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, Shandong, China; Department of Neurosurgery, The Third People's Hospital of Jinan, Jinan, Shandong, China.
Rucai
R
Zhan
Department of Medical Imaging, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Zhenshen
Z
Ma
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, Shandong, China.
Donghai
D
Wang
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, Shandong, China. Electronic address: lixg@sdu.edu.cn.
Xingang
X
Li
D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000375:Aging; D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D003919:Diabetes Insipidus / Q000188:drug therapy / Q000209:etiology; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects* / Q000379:methods*; D009666:Nose; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013101:Sphenoid Sinus; D016896:Treatment Outcome
Complications; Elderly patients; Endoscopic endonasal transsphenoidal approach; Nonfunctioning pituitary adenoma; Surgical outcome