gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Transnasal-transsphenoidal surgery for pituitary adenoma in geriatric patients - Findings and long-term outcome

Transnasale-transsphenoidale Hypophysenoperationen beim geriatrischen Patienten – Befunde und Langzeit-Resultate

Meeting Abstract

  • corresponding author Thomas Kretschmer - Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg
  • K. Seitz - Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg
  • G. Antoniadis - Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg
  • W. Börm - Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg
  • H.-P. Richter - Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg
  • R. König - Neurochirurgische Klinik der Universität Ulm am BKH Günzburg, Günzburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.02.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0247.shtml

Veröffentlicht: 23. April 2004

© 2004 Kretschmer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective

A geriatric patient group operated on for pituitary adenoma was to be evaluated for preoperative findings and long-term outcome in order to relate potential benefits to the morbidity and potential risks of the procedure.

Methods

Retrospective evaluation of patients 70 years and older, that had been amongst a group of patients operated transnasally for pituitary adenoma between 1/93 and 12/01. Preoperative findings, surgical reports and long-term clinical, radiological, ophthalmological and endocrinological status follow-up were evaluated.

Results

Preop: Amongst 124 transnasally-transsphenoidally operated pituitary adenoma cases, were 25 (20%) geriatric patients (max 80, mean and median 73 years). All geriatric patients had a macroadenoma, the average max. diameter was 2,7 cm. In 23 (92%) cases the chiasm was reached (5/23) or compressed (18/23), 20 (80%) had visual disturbances, 17/24 (71%) had anterior lobe insufficiency (5/17 complete, 12/17 partial insufficiency), 1 had to be substituted preoperatively. The single, most frequent clinical symptom was visual disturbance. Immediate postoperative period: 2 postop haematomas necessitated evacuation; there were no CSF fistulas. None of the 25 patients suffered from deterioration of visual disturbances. Diabetes insipidus had to be treated in 9/25 (36%) cases (8/9 with transient, 1/9 with permanent DI), hydrocortisone was routinely administered. Average length of hospital stay was 13 days. Histology: Chromophobic (zero-cell) adenoma was the usual diagnosis (22/25, 88%). Postop long-term: Median follow-up time was 3 years. In 15/20 (75%) cases visual status improved. For 6/23 (26%) patients the preoperative endocrinology improved. 18/23 (78%) patients still had to be substituted, in 3/23 (13%) substitution surpassed the preoperative extent. 13/22 (59%) patients with proper radiological follow-up had no recurrency or tumour remnant (3 recurrencies, 2 requiring surgery; 6 remnants, 5 of minor, non progressive extent).

Conclusions

The portion of macroadenomas and visual defects amongst geriatric patients diagnosed with pituitary adenoma is immense. The postoperative course is quite encouraging. Visual disturbances, even if long lasting, can be influenced positively in most cases. The majority requires permanent substitution. Tn-ts pituitary surgery should be offered to elderly patients, outcome is excellent.