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Acta Neurochirurgica
Published in: Acta Neurochirurgica 11/2023

22-09-2023 | Pituitary Adenoma | Original Article

Pituitary surgery outcome in patients 75 years and older: a retrospective study

Authors: Marta Garvayo, Chiara Villa, Anne Jouinot, Mahmoud Messerer, Vincent Reina, Mirella Hage, Marie-Laure Raffin-Sanson, Carine Courtillot, Anne Bachelot, Peter Kamenicky, Philippe Chanson, Camille Vatier, Sophie Christin-Maitre, Jérôme Bertherat, Guillaume Assié, Stephan Gaillard, Bertrand Baussart

Published in: Acta Neurochirurgica | Issue 11/2023

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Abstract

Background

As the population ages, the number of elderly patients with an indication for pituitary surgery is rising. Information on the outcome of patients aged over 75 is limited. This study reports a large series assessing the feasibility of surgical resection in this specific age range, focusing on surgical complications and postoperative results.

Methods

A retrospective cohort study of patients with pituitary adenomas and Rathke’s cleft cysts was conducted. All patients were aged 75 years or over and treated by a single expert neurosurgical team. A control population included 2379 younger adult patients operated by the same surgeons during the same period.

Results

Between 2008 and 2022, 155 patients underwent surgery. Indication was based on vision impairment in most patients (79%). Median follow-up was 13 months (range: 3–96). The first surgery was performed with an endoscopic transsellar approach, an extended endonasal transtuberculum approach and a microscopic transcranial approach in 96%, 3%, and 1% of patients, respectively. Single surgery was sufficient to obtain volume control in 97% of patients. From Kaplan-Meier estimates, 2-year and 5-year disease control with a single surgery were 97.3% and 86.2%, respectively. Resection higher than 80% was achieved in 77% of patients. No vision worsening occurred. In acromegaly and Cushing’s disease, endocrine remission was obtained in 90% of non-invasive adenomas. Surgical complications were noted in 5% of patients, with 30-day mortality, hematoma, cerebrospinal fluid leak, meningitis, and epistaxis occurring in 0.6%, 0.6%, 1.9%, 0.6%, and 1.3% respectively. New endocrine anterior deficits occurred in only 5%, while no persistent diabetes insipidus was noted. Compared with younger patients, the complication rate was not statistically different.

Conclusions

Surgery beyond the age of 75, mainly relying on an endoscopic endonasal transsellar approach, is effective and safe, provided that patients are managed in tertiary centers.
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Metadata
Title
Pituitary surgery outcome in patients 75 years and older: a retrospective study
Authors
Marta Garvayo
Chiara Villa
Anne Jouinot
Mahmoud Messerer
Vincent Reina
Mirella Hage
Marie-Laure Raffin-Sanson
Carine Courtillot
Anne Bachelot
Peter Kamenicky
Philippe Chanson
Camille Vatier
Sophie Christin-Maitre
Jérôme Bertherat
Guillaume Assié
Stephan Gaillard
Bertrand Baussart
Publication date
22-09-2023
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 11/2023
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-023-05809-x

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