Treatment of non-functional pituitary adenoma in the elderly with endoscopic endonasal transsphenoidal approach

Objective To investigate the safety and effectiveness of endoscopic endonasal transsphenoidal surgery in old patients with non-functional pituitary adenoma. Methods From January 2009 to December 2014, the clinical data of 34 patients (≥65 years) with non-functional pituitary adenoma treated with endoscopic endonasal transsphenoidal surgery at the Department of Neurosurgery, Wuxi Second Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. Twelve patients were treated unilaterally by transnasal endoscopic operation and 22 were treated bilaterally by transanal endoscopic surgery. Results The tumors of 27 patients (79.4%) were resected totally, 4 (11.8%) were resected near totally, 2 (5.9%) were resected subtotlly, and 1 (2.9%) died. The postoperative visual acuity was improved in 26 cases (92.9%, 26/28) and did not have any change in 2 cases (7.1%, 2/28). Ten patients (29.4%) had postoperative diabetes insipidus, 2 (5.9%) had cerebrospinal fluid rhinorrhea and 2 had new hypopituitarism. Thirty patients were followed up for 3 months to 5 years. Ten patients had hypopituitarism, 1 had anosmia, 1 had sinusitis, and 1 had epistaxis. Of the 6 patients with residual tumor, 2 were treated with radiation therapy after recurrence. Conclusions Although the operation risk of the elderly patients with non-functional pituitary adenoma is relatively high, using endoscopic endonasal transsphenoidal surgery is safe and feasible through the strengthening of perioperative multidisciplinary collaboration. Key words: Pituitary neoplasms; Neuroendoscopes; Transsphenoidal surgery; Aged