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Transsphenoidal surgical treatment of pituitary adenomas in patients aged 80 years or older

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Abstract

To know the clinical characteristics of pituitary adenomas in the elderly patients aged 80 years or older who were surgically treated. From 1995 through 2012, 907 patients underwent surgery for the pituitary adenomas at Kagoshima- and Hiroshima University hospitals in Japan. Ten (1.1 %) patients were aged 80 years or older. We retrospectively assessed the clinical characteristics including preoperative comorbidities, manifestations, neuroimaging findings, and endocrinologic features of these ten patients. The subjects included eight males and two females. Their ages ranged from 80 to 86 with mean of 83.1 years. Of these, besides one case of growth hormone-producing adenoma, others were clinically nonfunctioning adenoma. Six patients had modest comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, or chronic kidney dysfunction, and all patients were classified into grade 2–3 on American Society of Anesthesiologists’ Physical Status grading. Transsphenoidal surgery was performed in all due to visual disturbance in eight, diabetes mellitus as an intercurrent illness of acromegaly in one, and for the purpose of preventing visual disturbance in one patient who had an adenoma impinging optic chiasm but still had normal visual field. The surgeries provided sufficient decompression of the optic pathways and improved visual disorder in all. In an acromegalic male, his comorbidities considerably improved. No permanent surgical morbidity ensued. More than three axes of anterior pituitary hormones were preoperatively impaired in all, which were rarely recovered. Transsphenoidal surgery is safe and efficient treatment way for patients aged 80 years or older with pituitary adenomas with chiasmatic symptoms when the patients’ general condition is well preserved and pituitary hormonal deficiency is adequately replaced.

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Acknowledgments

This work was supported (in part) by Grants-in-Aid for Scientific Research (Research on Hypothalamo-Pituitary Dysfunction) from the Ministry of Health, Labor and Welfare, Japan.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan

    Shunji Yunoue, Hiroshi Tokimura, Shingo Fujio, Prasanna Karki, Mika Habu, FM Moinuddin, Hirofumi Hirano & Kazunori Arita

  2. Department of Neurosurgery, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

    Atsushi Tominaga, Satoshi Usui & Yasuyuki Kinoshita

Authors
  1. Shunji Yunoue
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  2. Hiroshi Tokimura
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  3. Atsushi Tominaga
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  4. Shingo Fujio
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  5. Prasanna Karki
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  6. Satoshi Usui
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  7. Yasuyuki Kinoshita
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  8. Mika Habu
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  9. FM Moinuddin
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  10. Hirofumi Hirano
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  11. Kazunori Arita
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Correspondence to Hiroshi Tokimura.

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Comments

Shang-Hang Shen, Xiamen, China

The authors discussed an interesting topic about the transsphenoidal surgical treatment of pituitary adenomas in most elderly people—80 years or older. The transsphenoidal approach has been accepted as a safe approach for pituitary adenomas by most neurosurgeons in the world. Although age alone is not a contraindication for active treatment with this approach, there are still few reports about pituitary adenomas in patients aged 80 or more. As general population is rapidly aging, the importance of the topics about highest age patients will be even more important.

The study is a retrospectively research of a group of 10 cases of elderly pituitary adenomas patients (age 80 to 86 years, mean 83.1 years) and physical condition of ASA-PS grading 2 or 3. The follow-up period ranged from 5.3 to 99.3 months with mean of 37.9 months. The average age of the patients in this study is higher than in other papers on the topic. All the patients underwent transsphenoidal surgery under surgical microscope with aid of endoscopic observation and received sufficient decompression of optic pathways and improved visual disorder. The authors conclude that transsphenoidal surgery is safe and efficient treatment for patients aged 80 years of older with pituitary adenomas with chiasmatic symptoms provided the patients’ general condition is well preserved and pituitary hormonal deficiency is adequately replaced.

Usually, pituitary adenomas can be resected successfully with both transcranial and transsphenoidal approaches. The transcranial approach allows for a significant achievement in optic pathway decompression, but sometimes, it also causes disturbance to the nerves, vessels, and brain around the tumor or on the operational way. As a newer and well-developed surgery, transsphenoidal surgery under surgical microscope, with the aid of both microscope and endoscopic observation, or only with the aid of endoscopy, has been indicated a safer and also efficient way in the surgical treatment of pituitary adenomas, even the aged patient can well survive the surgery (see references 1–4 at the end of this comment).

The question of whether older patients with pituitary adenomas should be operated is still a matter of debate. The important issue of course is the safety and efficiency of the particular operative technique. In patients without tumor-related symptoms, follow-up with regular MRI and perimetry may be the better choice. If, however, the tumor causes significant symptoms, the surgery will become necessary. In this study, the authors give us a clear demonstration that older patients with pituitary adenomas whose general condition is well can also tolerate transsphenoidal surgery and have good outcome after operation.

References

1. Hasegawa Y, Yano S, Sakurama T (2011) Endoscopic surgical treatment for pituitary apoplexy in three elderly patients over the age of 80. Acta Neurochir Suppl 111:429–433

2. Locatelli M, Bertani G, Carrabba G, Mantovani G, Lania A, et al. (2013) The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk. Pituitary 16(2):146–151

3. Hong J, Ding X, Lu Y (2008) Clinical analysis of 103 elderly patients with pituitary adenomas: transsphenoidal surgery and follow-up. J Clin Neurosci 15(10):1091–1095

4. Sheehan JM, Douds GL, Hill K, et al. (2008) Transsphenoidal surgery for pituitary adenoma in elderly patients. Acta Neurochir (Wien) 150(6):571–574; discussion 574

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Yunoue, S., Tokimura, H., Tominaga, A. et al. Transsphenoidal surgical treatment of pituitary adenomas in patients aged 80 years or older. Neurosurg Rev 37, 269–277 (2014). https://doi.org/10.1007/s10143-013-0509-3

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