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Transsphenoidal resection for pituitary adenoma in elderly versus younger patients: a systematic review and meta-analysis

  • Original Article - Pituitaries
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Abstract

Introduction

Pituitary adenomas (PA) are common intracranial tumors. In the context of the aging of the population, the question is whether postsurgical outcomes are comparable to the younger ones. The primary objective of the present study was to review published resection and recurrence rates after transsphenoidal resection. The secondary aim was to evaluate visual improvement and complication rates.

Methods

The authors searched PubMed and Medline databases, of published English series, with no time frame limit, evaluating outcomes of transsphenoidal resection in populations aged more or less than 65, 70, and 80 years. We performed a systematic review and meta-analysis.

Results

Median overall resection rates for younger population was 70.7% (range 54–76.8) and for elderly one was 65.7% (range 16.6–78.2) (two-sample t test, p = 0.35). The only statistically significant difference for gross total resection rates (GTR) favored patients aged less than 80 (p = 0.01). There was no statistically significant difference among recurrence rates. There was a statistically significant difference for visual improvement favoring patients aged more than 80 (p = 0.03). For the age groups of less versus more than 70, there was a statistically significant difference for overall complication rate favoring younger groups (p < 0.05).

Conclusion

Present data shows GTR rates favoring younger patients. Recurrence rates remain similar over the mean follow-up period. Moreover, visual improvement favors patients aged more than 80. Overall complication rates favor patients younger than 70, which might be also related to additional comorbidities, frequently present in seniors. Transsphenoidal surgery is safe and effective even for older patients.

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References

  1. Agam MS, Zada G (2018) Complications associated with transsphenoidal pituitary surgery: review of the literature. Neurosurgery 65:69–73

    Article  PubMed  Google Scholar 

  2. Black PM, Zervas NT, Candia G (1988) Management of large pituitary adenomas by transsphenoidal surgery. Surg Neurol 29:443–447

    Article  CAS  PubMed  Google Scholar 

  3. • Capatina C, Christodoulides C, Fernandez A, Cudlip S, Grossman AB, Wass JA, Karavitaki N (2012) Current treatment protocols can offer a normal or near normal quality of life in the majority of patients with non-functioning pituitary adenomas. Clin Endocrinol. https://doi.org/10.1111/j.1365-2265.2012.04449.x

  4. Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298

    Article  PubMed  Google Scholar 

  5. Cappabianca P, Solari D (2012) The endoscopic endonasal approach for the treatment of recurrent or residual pituitary adenomas: widening what to see expands what to do? World Neurosurg 77:455–456

    Article  PubMed  Google Scholar 

  6. Castinetti F, Regis J, Dufour H, Brue T (2010) Role of stereotactic radiosurgery in the management of pituitary adenomas. Nat Rev Endocrinol 6:214–223

    Article  PubMed  Google Scholar 

  7. Chanson P, Maiter D (2019) The epidemiology, diagnosis and treatment of prolactinomas: the old and the new. Best practice & research. Clin Endocrinol Metab 33:101290

    Google Scholar 

  8. Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S, French Endocrinology Society non-functioning pituitary adenoma w-g (2015) Management of clinically non-functioning pituitary adenoma. Ann Endocrinol 76:239–247

    Article  Google Scholar 

  9. Chen SH, Sprau A, Chieng L, Buttrick S, Alam ES, Ali SC, Madhavan K, Sargi ZB, Komotar R (2019) Transsphenoidal approach for pituitary adenomas in elderly patients. World Neurosurg 121:e670–e674

    Article  PubMed  Google Scholar 

  10. • Chen Y, Wang CD, Su ZP, Chen YX, Cai L, Zhuge QC, Wu ZB (2012) Natural history of postoperative nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Neuroendocrinology. https://doi.org/10.1159/000339823

  11. Chinezu R, Fomekong F, Lasolle H, Trouillas J, Vasiljevic A, Raverot G, Jouanneau E (2017) Risks and benefits of endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas in patients of the ninth decade. World Neurosurg 106:315–321

    Article  PubMed  Google Scholar 

  12. Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40:225–236 discussion 236-227

    Article  CAS  PubMed  Google Scholar 

  14. • Cordeiro D, Xu Z, Mehta GU, Ding D, Vance ML, Kano H, Sisterson N, Yang HC, Kondziolka D, Lunsford LD, Mathieu D, Barnett GH, Chiang V, Lee J, Sneed P, Su YH, Lee CC, Krsek M, Liscak R, Nabeel AM, El-Shehaby A, Karim KA, Reda WA, Martinez-Moreno N, Martinez-Alvarez R, Blas K, Grills I, Lee KC, Kosak M, Cifarelli CP, Katsevman GA, Sheehan JP (2018) Hypopituitarism after Gamma Knife radiosurgery for pituitary adenomas: a multicenter, international study. J Neurosurg. https://doi.org/10.3171/2018.5.JNS18509

  15. D’Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B (2009) Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 72:336–340

    Article  PubMed  Google Scholar 

  16. Dai CX, Yao Y, Cai F, Liu XH, Ma SH, Wang RZ (2012) Advances in medical treatment of clinically nonfunctioning pituitary adenomas. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 34:298–302

    CAS  PubMed  Google Scholar 

  17. Daniel RT, Tuleasca C, Messerer M, Negretti L, George M, Pasche P, M L (2013) Optimally invasive skull base surgery for large benign tumors. In: Berhouma M (ed) Minimally invasive skull base surgery: principles and practice. Nova Science Publishers, pp 325–355

  18. de Divitiis E (2006) Endoscopic transsphenoidal surgery: stone-in-the-pond effect. Neurosurgery 59:512–520 discussion 512-520

    Article  PubMed  Google Scholar 

  19. de Voogd S, Ikram MK, Wolfs RC, Jansonius NM, Hofman A, de Jong PT (2005) Incidence of open-angle glaucoma in a general elderly population: the Rotterdam Study. Ophthalmology 112:1487–1493

    Article  PubMed  Google Scholar 

  20. Dehdashti AR, Ganna A, Karabatsou K, Gentili F (2008) Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62:1006–1015 discussion 1015-1007

    Article  PubMed  Google Scholar 

  21. Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, McCutcheon IE (2004) The prevalence of pituitary adenomas: a systematic review. Cancer 101:613–619

    Article  PubMed  Google Scholar 

  22. Fernandez-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Perez L, Ponce de Leon-Lovaton PG, Erwin PJ, Carey J, Montori VM (2011) Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab 96:905–912

    Article  CAS  PubMed  Google Scholar 

  23. Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83:240–248

    Article  CAS  PubMed  Google Scholar 

  24. Fujimoto K, Yano S, Shinojima N, Hide T, Kuratsu JI (2017) Endoscopic endonasal transsphenoidal surgery for patients aged over 80 years with pituitary adenomas: surgical and follow-up results. Surg Neurol Int 8:213

    Article  PubMed  PubMed Central  Google Scholar 

  25. Girkin CA, Comey CH, Lunsford LD, Goodman ML, Kline LB (1997) Radiation optic neuropathy after stereotactic radiosurgery. Ophthalmology 104:1634–1643

    Article  CAS  PubMed  Google Scholar 

  26. Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Mota JI (2015) Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg 123:31–38

    Article  PubMed  Google Scholar 

  27. Greenberg MS (2006) Pituitary adenomas. In: Thieme (ed) Handbook of neurosurgery, pp 438–456

    Google Scholar 

  28. Huo G, Feng QL, Tang MY, Li D (2011) Diagnosis and treatment of hemorrhagic pituitary adenomas. Acta Neurochir Suppl 111:361–365

    Article  PubMed  Google Scholar 

  29. Jane JA Jr, Laws ER Jr (2001) The surgical management of pituitary adenomas in a series of 3,093 patients. J Am Coll Surg 193:651–659

    Article  PubMed  Google Scholar 

  30. Jho HD (2001) Endoscopic transsphenoidal surgery. J Neuro-Oncol 54:187–195

    Article  CAS  Google Scholar 

  31. Kabil MS, Eby JB, Shahinian HK (2005) Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg 48:348–354

    Article  CAS  PubMed  Google Scholar 

  32. Karavitaki N, Collison K, Halliday J, Byrne JV, Price P, Cudlip S, Wass JA (2007) What is the natural history of nonoperated nonfunctioning pituitary adenomas? Clin Endocrinol 67:938–943

    Article  CAS  Google Scholar 

  33. Klein BE, Klein R, Lee KE (1998) Incidence of age-related cataract: the Beaver Dam Eye Study. Arch Ophthalmol 116:219–225

    CAS  PubMed  Google Scholar 

  34. Kuratsu J, Ushio Y (1997) Epidemiological study of primary intracranial tumours in elderly people. J Neurol Neurosurg Psychiatry 63:116–118

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kurosaki M, Saeger W, Ludecke DK (2001) Pituitary tumors in the elderly. Pathol Res Pract 197:493–497

    Article  CAS  PubMed  Google Scholar 

  36. Leavitt JA, Stafford SL, Link MJ, Pollock BE (2013) Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 87:524–527

    Article  PubMed  Google Scholar 

  37. Leveziel N, Delcourt C, Zerbib J, Dollfus H, Kaplan J, Benlian P, Coscas G, Souied EH, Soubrane G (2009) Epidemiology of age related macular degeneration. Journal francais d’ophtalmologie 32:440–451

    Article  CAS  PubMed  Google Scholar 

  38. Liu J, Li C, Xiao Q, Gan C, Chen X, Sun W, Li X, Xu Y, Chen J, Shu K, Lei T (2015) Comparison of pituitary adenomas in elderly and younger adults: clinical characteristics, surgical outcomes, and prognosis. J Am Geriatr Soc 63:1924–1930

    Article  PubMed  Google Scholar 

  39. Mehta RP, Cueva RA, Brown JD, Fliss DM, Gil Z, Kassam AB, Rassekh CH, Schlosser RJ, Snyderman CH, Har-El G (2006) What’s new in skull base medicine and surgery? Skull Base Committee Report. Otolaryngol Head Neck Surg 135:620–630

    Article  PubMed  Google Scholar 

  40. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine S (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:273–288

    Article  CAS  PubMed  Google Scholar 

  41. Messerer M, De Battista JC, Raverot G, Kassis S, Dubourg J, Lapras V, Trouillas J, Perrin G, Jouanneau E (2011) Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal. Neurosurg Focus 30:E11

    Article  PubMed  Google Scholar 

  42. Minniti G, Esposito V, Piccirilli M, Fratticci A, Santoro A, Jaffrain-Rea ML (2005) Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature. Eur J Endocrinol 153:723–735

    Article  CAS  PubMed  Google Scholar 

  43. Molitch ME (2017) Diagnosis and treatment of pituitary adenomas: a review. Jama 317:516–524

    Article  PubMed  Google Scholar 

  44. Murad MH, Fernandez-Balsells MM, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Perez L, Ponce de Leon-Lovaton PG, Albuquerque FN, Carey J, Erwin PJ, Montori VM (2010) Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Clin Endocrinol 73:777–791

    Article  Google Scholar 

  45. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834

    Article  CAS  PubMed  Google Scholar 

  46. Pereira AM, Biermasz NR (2012) Treatment of nonfunctioning pituitary adenomas: what were the contributions of the last 10 years? A critical view. Ann Endocrinol (Paris) 73:111–116

    Article  Google Scholar 

  47. Pollock BE, Link MJ, Leavitt JA, Stafford SL (2014) Dose-volume analysis of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Neurosurgery 75:456–460 discussion 460

    Article  PubMed  Google Scholar 

  48. Racadot J (1980) Adenomas of the anterior pituitary : natural history, classification and histopathology. Rev Prat 30:2981-2984, 2987-2992, 2997-2988 passim

    Google Scholar 

  49. Robenshtok E, Benbassat CA, Hirsch D, Tzvetov G, Cohen ZR, Iraqi HM, Gorshtein A, Toledano Y, Shimon I (2014) Clinical course and outcome of nonfunctioning pituitary adenomas in the elderly compared with younger age groups. Endocr Pract 20:159–164

    Article  PubMed  Google Scholar 

  50. Semple PL, Laws ER Jr (1999) Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing’s disease. J Neurosurg 91:175–179

    Article  CAS  PubMed  Google Scholar 

  51. Sheehan JP, Jagannathan J, Pouratian N, Steiner L (2006) Stereotactic radiosurgery for pituitary adenomas: a review of the literature and our experience. Front Horm Res 34:185–205

    Article  PubMed  Google Scholar 

  52. Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD (2002) Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg 97:408–414

    Article  PubMed  Google Scholar 

  53. Sheehan JP, Niranjan A, Sheehan JM, Jane JA Jr, Laws ER, Kondziolka D, Flickinger J, Landolt AM, Loeffler JS, Lunsford LD (2005) Stereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurg 102:678–691

    Article  PubMed  Google Scholar 

  54. Sheehan JP, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL, Lee JY, Kano H, Park KJ, Niranjan A, Kondziolka D, Barnett GH, Rush S, Golfinos JG, Lunsford LD (2013) Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119:446–456

    Article  PubMed  Google Scholar 

  55. Tabaee A, Anand VK, Barron Y, Hiltzik DH, Brown SM, Kacker A, Mazumdar M, Schwartz TH (2009) Predictors of short-term outcomes following endoscopic pituitary surgery. Clin Neurol Neurosurg 111:119–122

    Article  PubMed  Google Scholar 

  56. Tampourlou M, Trifanescu R, Paluzzi A, Ahmed SK, Karavitaki N (2016) Therapy of endocrine disease: surgery in microprolactinomas: effectiveness and risks based on contemporary literature. Eur J Endocrinol 175:R89–R96

    Article  CAS  PubMed  Google Scholar 

  57. Trouillas J, Roy P, Sturm N, Dantony E, Cortet-Rudelli C, Viennet G, Bonneville JF, Assaker R, Auger C, Brue T, Cornelius A, Dufour H, Jouanneau E, Francois P, Galland F, Mougel F, Chapuis F, Villeneuve L, Maurage CA, Figarella-Branger D, Raverot G, members of H, Barlier A, Bernier M, Bonnet F, Borson-Chazot F, Brassier G, Caulet-Maugendre S, Chabre O, Chanson P, Cottier JF, Delemer B, Delgrange E, Di Tommaso L, Eimer S, Gaillard S, Jan M, Girard JJ, Lapras V, Loiseau H, Passagia JG, Patey M, Penfornis A, Poirier JY, Perrin G, Tabarin A (2013) A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol 126:123–135

    Article  PubMed  Google Scholar 

  58. Tuleasca C, Leroy HA, Regis J, Levivier M (2016) Gamma Knife radiosurgery for cervical spine lesions: expanding the indications in the new era of Icon. Acta Neurochir 158:2235–2236

    Article  PubMed  Google Scholar 

  59. Wilson PJ, Omay SB, Kacker A, Anand VK, Schwartz TH (2018) Endonasal endoscopic pituitary surgery in the elderly. J Neurosurg 128:429–436

    Article  PubMed  Google Scholar 

  60. Woodworth GF, Patel KS, Shin B, Burkhardt JK, Tsiouris AJ, McCoul ED, Anand VK, Schwartz TH (2014) Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus. J Neurosurg 120:1086–1094

    Article  PubMed  PubMed Central  Google Scholar 

  61. Zhan R, Ma Z, Wang D, Li X (2015) Pure endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary adenomas in the elderly: surgical outcomes and complications in 158 patients. World Neurosurg 84:1572–1578

    Article  PubMed  Google Scholar 

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Funding

Constantin Tuleasca gratefully acknowledges receipt of a “Young Researcher in Clinical Research Grant” (Jeune Chercheur en Recherche Clinique) from the Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), and the Lausanne University Hospital (CHUV).

Author information

Author notes

  1. Dr. Tuleasca, Dr. Ducos, and Leroy equally contributed as first authors

Authors and Affiliations

  1. Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Constantin Tuleasca & Marc Levivier

  2. Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland

    Constantin Tuleasca & Marc Levivier

  3. Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Constantin Tuleasca

  4. Faculté de Médecine, Sorbonne Université, Paris, France

    Constantin Tuleasca & Yohan Ducos

  5. Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France- 78, Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    Constantin Tuleasca, Yohan Ducos, Steven Knafo, Nozar Aghakhani & Fabrice Parker

  6. Centre Hospitalier Universitaire Régional de Lille, Roger Salengro Hospital, Lille, France

    Constantin Tuleasca & Henri-Arthur Leroy

  7. Servicve d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des mladies rares de l’Hypophyse, Hôpitaux Universitaires Paris-Saclay (site Bicêtre), Assistance Publique-Hôpitaux de Paris, F94275, Le Kremlin-Bicêtre, France

    Philippe Chanson

  8. Faculté de Médecine Paris-Sud, Université Paris-Sud, Université Paris-Saclay, F94276, Le Kremlin-Bicêtre, France

    Philippe Chanson, Steven Knafo, Nozar Aghakhani & Fabrice Parker

  9. INSERM UMR S-1185, Faculté de Médecine Paris-Sud, F94276, Le Kremlin-Bicêtre, France

    Philippe Chanson

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  1. Constantin Tuleasca
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  2. Yohan Ducos
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  3. Henri-Arthur Leroy
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  4. Philippe Chanson
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  5. Steven Knafo
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  6. Marc Levivier
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  8. Fabrice Parker
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Correspondence to Constantin Tuleasca.

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Tuleasca, C., Ducos, Y., Leroy, HA. et al. Transsphenoidal resection for pituitary adenoma in elderly versus younger patients: a systematic review and meta-analysis. Acta Neurochir 162, 1297–1308 (2020). https://doi.org/10.1007/s00701-020-04300-1

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