Artikel
Surgical outcome of the transsphenoidal approach in patients > 70 years with sella pathologies
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: As the proportion of elderly patients in the population increases, we still lack of age-related data concerning complication and benefit in neurosurgical procedures. In this study we evaluated indication, safety and effectiveness of the transsphenoidal approach in patients > 70 years with sella pathologies.
Method: 256 patients presented to our department with sella pathologies from 2007-2015. Sella pathologies were categorized according to entity and frequency. We reviewed our indication for surgical and non-surgical treatment with regard to clinical symptoms and evaluated postoperative complications and benefit in patients > 70 years old.
Results: 40/256 patients (15%) were 70 years and over. 32/40 patients underwent transsphenoidal surgery, 1/40 patient transcranial surgery, 7/40 received non-surgical treatment. The most frequent sella pathology in our series of patients > 70 was non-functioning pituitary adenoma (26), followed by craniopharyngioma (2), chordoma (2), pituitary apoplexy (2), lymphoma (2), hemorrhagic Rathke's cleft cyst (1), xanthogranuloma (1), hemorrhagic prolactinoma, nasopharyngeal carcinoma (1), mucocele (1) and meningioma (1). The average age of our patients was 76 years. The oldest patient was 85-year-old. Prior to surgery the most frequent symptoms were chiasmal syndrome and hypopituitarism, followed by sinus cavernosus syndrome and acute hemorrhage with mass effect. 8 patients were admitted as emergency cases, 32 patients electively. In 57% of the cases visual dysfunction improved after surgery, in 1 case visual acuity worsened. CSF leakage occurred in 4 cases. 1 patient developed transient diabetes insipidus. Hydrocephalus occurred in 1 case, postoperative hemorrhage in 2 cases. We recorded no case of meningitis. 2 patients recovered from the neurosurgical treatment, but died of malignant comorbidities. 1 patient died of abdominal complication.
Conclusions: Neurosurgical treatment in the older population is an ethical and surgical challenge. The entity of pathologies or age alone did not crucially determine the decision for surgery. Indication for neurosurgical treatment should be approved carefully, thoroughly, individually and with regard to clinical symptoms. Transsphenoidal approach can be considered as an effective way to treat sella pathologies in elderly patients.