Endoscopic transsphenoidal surgery for biochemically and clinically non-functioning adenohypophyseal tumours in the elderly: experience from a single UK centre.
Adenohypophyseal tumour
Elderly
Endoscopic transsphenoidal surgery
Pituitary adenoma
Pituitary tumour
Journal
Endocrine
ISSN: 1559-0100
Titre abrégé: Endocrine
Pays: United States
ID NLM: 9434444
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
11
08
2021
accepted:
13
10
2021
pubmed:
7
11
2021
medline:
24
3
2022
entrez:
6
11
2021
Statut:
ppublish
Résumé
To assess and compare outcome of surgical management of non-functioning pituitary adenohypophyseal tumours in patients under 65-years, and 65-years and older at tertiary neurosurgical referral centre. Data was retrospectively analysed from pituitary database. Forty-four patients aged 65 or older (Group 1) and 93 patients under 65 (Group 2) underwent endoscopic trans-sphenoidal surgery (ETSS) between January 2017 and July 2019. The surgical, endocrinological, ophthalmological and radiological outcomes were compared. 6.8% of Group 1 patients had peri-operative surgical complications compared to 12.9% in Group 2 (p = 0.29). Improved visual fields and acuity were seen in 65.2% and 82.8% of Group 1 and Group 2 respectively (p = 0.124), although there were pre-existing ocular problems in 15.9% of Group 1. New hormone deficiencies were observed in 31.8% of Group 1 patients, and 24.7% of Group 2 (p = 0.555). Tumour regrowth/recurrence was seen in 2.3% of Group 1 (p = 0.553). The rate of repeat surgery was 6.8% in the Group 1 and 12.9% in Group 2 (p = 0.28). There was no significant relationship between extent of resection, complications or hormonal deficiency. The mean duration of follow-up was 10.5 ± 13.0 months for Group 1 patients and 13.0 ± 16.0 months for Group 2 patients (p = 0.526). ETSS for non-functioning pituitary adenohypophyseal tumours is safe and well tolerated in the patients aged 65 and older. Advanced age by itself should not be a contra-indication for ETSS. It is however highly recommended that the care of such patients to be offered at a high volume, dedicated pituitary surgical units.
Identifiants
pubmed: 34741239
doi: 10.1007/s12020-021-02910-y
pii: 10.1007/s12020-021-02910-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
872-882Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
M. Araujo-Castro, V.R. Berrocal, E. Pascual-Corrales, Pituitary tumors: epidemiology and clinical presentation spectrum. Hormones 19(2), 145–155 (2020). https://doi.org/10.1007/s42000-019-00168-8
doi: 10.1007/s42000-019-00168-8
pubmed: 31933100
B.D. McDowell, R.B. Wallace, R.M. Carnahan, E.A. Chrischilles, C.F. Lynch, J.A. Schlechte, Demographic differences in incidence for pituitary adenoma. Pituitary 14(1), 23–30 (2011). https://doi.org/10.1007/s11102-010-0253-4
doi: 10.1007/s11102-010-0253-4
pubmed: 20809113
pmcid: 3652258
A. Spina, M. Losa, P. Mortini, Pituitary adenomas in elderly patients: clinical and surgical outcome analysis in a large series. Endocrine 65(3), 637–645 (2019). https://doi.org/10.1007/s12020-019-01959-0
doi: 10.1007/s12020-019-01959-0
pubmed: 31209675
United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Ageing 2019: Highlights (ST/ESA/SER.A/430). https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf .
N. Maldaner, J. Sarnthein, O. Bozinov, L. Regli, M.C. Neidert, Neurosurgery in octogenarians: a prospective study of perioperative morbidity, mortality, and complications in elderly patients. World Neurosurg. 110, e287–e295 (2018). https://doi.org/10.1016/j.wneu.2017.10.154
doi: 10.1016/j.wneu.2017.10.154
pubmed: 29113899
R. Chinezu, F. Fomekong, H. Lasolle et al. Risks and benefits of endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas in patients of the ninth decade. World Neurosurg. 106, 315–321 (2017). https://doi.org/10.1016/j.wneu.2017.06.151
doi: 10.1016/j.wneu.2017.06.151
pubmed: 28676462
E.A. Pereira, P. Plaha, A. Chari et al. Transsphenoidal pituitary surgery in the elderly is safe and effective. Br J Neurosurg 28(5), 616–621 (2014). https://doi.org/10.3109/02688697.2013.872225
doi: 10.3109/02688697.2013.872225
pubmed: 24377670
M.A. Azab, M. O’Hagan, H. Abou-Al-Shaar, M. Karsy, J. Guan, W.T. Couldwell, Safety and outcome of transsphenoidal pituitary adenoma resection in elderly patients. World Neurosurg. 122, e1252–e1258 (2019). https://doi.org/10.1016/j.wneu.2018.11.024
doi: 10.1016/j.wneu.2018.11.024
pubmed: 30447462
S.H. Chen, A. Sprau, L. Chieng et al. Transsphenoidal approach for pituitary adenomas in elderly patients. World Neurosurg. 121, e670–e674 (2019). https://doi.org/10.1016/j.wneu.2018.09.187
doi: 10.1016/j.wneu.2018.09.187
pubmed: 30292662
J.A. Gondim, J.P. Almeida, L.A. de Albuquerque, E. Gomes, M. Schops, J.I. Mota, Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg 123(1), 31–38 (2015). https://doi.org/10.3171/2014.10.JNS14372
doi: 10.3171/2014.10.JNS14372
pubmed: 25839926
Y. Kinoshita, K. Kurisu, K. Arita, Nonfunctioning pituitary adenomas in elderly patients. J Clin Neurosci 53, 127–131 (2018). https://doi.org/10.1016/j.jocn.2018.04.054
doi: 10.1016/j.jocn.2018.04.054
pubmed: 29739724
H.A. Marenco, S.T. Zymberg, P. Santos Rde, C.O. Ramalho, Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly. Arq Neuropsiquiatr 73(9), 764–769 (2015). https://doi.org/10.1590/0004-282X20150112
doi: 10.1590/0004-282X20150112
pubmed: 26352495
P.J. Wilson, S.B. Omay, A. Kacker, V.K. Anand, T.H. Schwartz, Endonasal endoscopic pituitary surgery in the elderly. J Neurosurg 128(2), 429–436 (2018). https://doi.org/10.3171/2016.11.JNS162286
doi: 10.3171/2016.11.JNS162286
pubmed: 28387628
R. Zhan, Z. Ma, D. Wang, X. Li, Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients. World Neurosurg. 84(6), 1572–1578 (2015). https://doi.org/10.1016/j.wneu.2015.08.035
doi: 10.1016/j.wneu.2015.08.035
pubmed: 26341428
M.K. Garg, H.C. Pathak, G. Singh, Subclinical pituitary apoplexy with preserved pituitary functions. Indian J Endocrinol Metab 18(1), 122–123 (2014). https://doi.org/10.4103/2230-8210.126597
doi: 10.4103/2230-8210.126597
pubmed: 24701449
pmcid: 3968724
S. Berkmann, J. Fandino, S. Zosso, H.E. Killer, L. Remonda, H. Landolt, Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions. J Neurosurg 115(3), 518–527 (2011). https://doi.org/10.3171/2011.4.JNS101568
doi: 10.3171/2011.4.JNS101568
pubmed: 21639700
H.A. Zaidi, K. De Los Reyes, G. Barkhoudarian et al. The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite. Neurosurg Focus 40(3), E18 (2016). https://doi.org/10.3171/2016.1.FOCUS15515
doi: 10.3171/2016.1.FOCUS15515
pubmed: 26926058
pmcid: 4992957
T. Watanabe, H. Uehara, G. Takeishi et al. Characteristics of preoperative visual disturbance and visual outcome after endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary adenoma in elderly patients. World Neurosurg. 126, e706–e712 (2019). https://doi.org/10.1016/j.wneu.2019.02.132
doi: 10.1016/j.wneu.2019.02.132
pubmed: 30849556
Office for National Statistics. Population estimates for the UK, England and Wales, Scotland and Northern Ireland, provisional: mid-2019. National and subnational mid-year population estimates for the UK and its constituent countries by administrative area, age and sex. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/mid2019
S.D. Preston, A.R. Southall, M. Nel, S.K. Das, Geriatric surgery is about disease, not age. J R Soc Med 101(8), 409–415 (2008). https://doi.org/10.1258/jrsm.2008.080035
doi: 10.1258/jrsm.2008.080035
pubmed: 18687864
pmcid: 2500244
V. Tardivo, F. Penner, D. Garbossa et al. Surgical management of pituitary adenomas: does age matter. Pituitary 23(2), 92–102 (2020). https://doi.org/10.1007/s11102-019-01014-1
doi: 10.1007/s11102-019-01014-1
pubmed: 31797173
C.D. Andela, M. Scharloo, A.M. Pereira, A.A. Kaptein, N.R. Biermasz, Quality of life (QoL) impairments in patients with a pituitary adenoma: a systematic review of QoL studies. Pituitary 18(5), 752–776 (2015). https://doi.org/10.1007/s11102-015-0636-7
doi: 10.1007/s11102-015-0636-7
pubmed: 25605584
F. Francis, I. Burger, E.M. Poll, A. Reineke, C.J. Strasburger, G. Dohmen, J.M. Gilsbach, I. Kreitschmann-Andermahr, Can cardiac surgery cause hypopituitarism? Pituitary 15(1), 30–36 (2012). https://doi.org/10.1007/s11102-011-0322-3
doi: 10.1007/s11102-011-0322-3
pubmed: 21706189