The surgical treatment of pituitary adenomas in the eighth decade

BACKGROUND The surgical treatment of pituitary adenomas in elderly patients (i.e., over 70 years of age) is a special problem because of the increased rate of perioperative complications and the reduced tolerance of postopera tive fluid and electrolyte imbalance. Therefore, the unquestionable progres s in the pharmacological and radiotherapy may not allow these patients the option of radical surgical treatment, We report our experience with the tra nssphenoidal procedure for pituitary adenomas in aged patients in an attemp t to contribute to a better definition of the actual role of surgery. METHODS Transsphenoidal surgery was performed in 11 patients over 70 years of age affected by various histological types of pituitary micro- and macro adenomas, ranging from Hardy Grade I through IIIc, Special care was dedicat ed to the postoperative treatment, in particular to water and electrolyte b alances, and to the immediate treatment of any pathological variation of th ese parameters. RESULTS We had no mortality and no postoperative adjunctive morbidity, All the patients recovered well from the operation with an average hospital sta y of 20 days. The tumor removal was complete in six cases and partial in th e remaining five. With an average follow-up of 2 years, we did observe only one case of symptomatic recurrence of the disease. CONCLUSIONS Transsphenoidal surgery in the elderly is feasible and quite sa fe in the hands of an experienced team, if special care is devoted to the p reoperative selection of patients and to the postoperative treatment of flu id and electrolyte imbalance. (C) 1999 by Elsevier Science Inc.