Article
Transnasal-transsphenoidal surgery for pituitary adenoma in geriatric patients - Findings and long-term outcome
Transnasale-transsphenoidale Hypophysenoperationen beim geriatrischen Patienten – Befunde und Langzeit-Resultate
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Published: | April 23, 2004 |
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Outline
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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.