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

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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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Abbreviations

CSF:

Cerebrospinal fluid

ASA:

American Society of Anesthesiologists Physical Status Classification System

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Authors and Affiliations

  1. Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de L’Hôpital, 75013, Paris, France

    Marta Garvayo, Vincent Reina, Stephan Gaillard & Bertrand Baussart

  2. Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland

    Marta Garvayo & Mahmoud Messerer

  3. Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France

    Chiara Villa, Anne Jouinot, Jérôme Bertherat, Guillaume Assié & Bertrand Baussart

  4. Department of Neuropathology, La Pitié-Salpêtière University Hospital, AP-HP, Sorbonne University, Paris, France

    Chiara Villa

  5. Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France

    Mirella Hage & Marie-Laure Raffin-Sanson

  6. Université de Versailles Saint-Quentin-en-Yvelines UFR Des Sciences de La Santé Simone Veil, Montigny-Le-Bretonneux, France

    Mirella Hage & Marie-Laure Raffin-Sanson

  7. Department of Endocrinology and Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France

    Carine Courtillot & Anne Bachelot

  8. Université Paris-Saclay, Inserm, Physiologie Et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie Et Des Maladies de La Reproduction, Centre de Référence des Maladies Rares de L’Hypophyse, Le Kremlin-Bicêtre, France

    Peter Kamenicky & Philippe Chanson

  9. Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement (CRMERC), Endo-ERN (Id 739527), Saint-Antoine Hospital, AP-HP, Paris, France

    Camille Vatier & Sophie Christin-Maitre

  10. Inserm UMRS938, Saint-Antoine Research Center, Sorbonne University, 75012, Paris, France

    Camille Vatier

  11. INSERM UMR-833, Trousseau Hospital, Paris, France

    Sophie Christin-Maitre

  12. Department of Endocrinology, Center of Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France

    Jérôme Bertherat & Guillaume Assié

Authors
  1. Marta Garvayo
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  2. Chiara Villa
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  3. Anne Jouinot
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  4. Mahmoud Messerer
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  5. Vincent Reina
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  6. Mirella Hage
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  7. Marie-Laure Raffin-Sanson
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  8. Carine Courtillot
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  9. Anne Bachelot
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  10. Peter Kamenicky
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  11. Philippe Chanson
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  12. Camille Vatier
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  14. Jérôme Bertherat
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  15. Guillaume Assié
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  16. Stephan Gaillard
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  17. Bertrand Baussart
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Correspondence to Bertrand Baussart.

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Garvayo, M., Villa, C., Jouinot, A. et al. Pituitary surgery outcome in patients 75 years and older: a retrospective study. Acta Neurochir 165, 3409–3420 (2023). https://doi.org/10.1007/s00701-023-05809-x

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