Surgical Outcomes of Endoscopic Transsphenoidal Pituitary Adenoma Resection in Elderly Versus Younger Patients

Abstract

Introduction Pituitary adenomas (PAs) are one of the most common type of intracranial neoplasm with increased incidence in elderly patients. The outcomes of endoscopic transsphenoidal surgery (ETS) specifically on elderly patients remains unclear. Methods We performed a retrospective cohort study to compare elderly patients (age 65 years) with non-elderly patients (age <65 years) who underwent ETS for PA from January 2005 to December 2021. Surgical outcomes, including extent of resection, complication profile, length of stay, and endocrinopathy rates, were compared between elderly and non-elderly patients. Results A total of 690 patients were included with 197 (29%) being elderly. Elderly patients showed higher rates of hypertension (p<0.05), myocardial infarction (p<0.01), and atrial fibrillation (p=0.01) but not other comorbidities. Elderly patients also had more frequent optic nerve involvement (72% of cases vs. 61%, p=0.01). Tumor characteristics and other patient variables were otherwise similar between younger and elderly patients. Postoperative CSF leaks (2% vs. 2%, p=0.8), 30-day readmission, reoperation, postoperative complications, and postoperative endocrinopathies were similar between younger and older patients. Subdividing patients into age <65, 65-79, and >80 also did not demonstrate a worsening of surgical outcomes with age. Conclusion For well selected elderly patients in experienced endoscopic skull base centers, good surgical outcomes similarly to younger patients may be achieved.