Transsphenoidal pituitary surgery in the elderly is safe and effective.
OBJECT: With an increasingly ageing population, the number of elderly people diagnosed with pituitary tumours continues to rise. There is a concern that with increasing age and comorbidities, there is higher anaesthetic risk, as well as peri-operative morbidity and mortality from pituitary surgery....
| Hlavní autoři: | , , , , , , , , , , , |
|---|---|
| Médium: | Journal article |
| Jazyk: | English |
| Vydáno: |
Informa Healthcare
2014
|
| _version_ | 1826301546269245440 |
|---|---|
| author | Pereira, E Plaha, P Chari, A Paranathala, M Haslam, N Rogers, A Korevaar, T Tran, D Olarinde, R Karavitaki, N Grossman, AB Cudlip, SA |
| author_facet | Pereira, E Plaha, P Chari, A Paranathala, M Haslam, N Rogers, A Korevaar, T Tran, D Olarinde, R Karavitaki, N Grossman, AB Cudlip, SA |
| author_sort | Pereira, E |
| collection | OXFORD |
| description | OBJECT: With an increasingly ageing population, the number of elderly people diagnosed with pituitary tumours continues to rise. There is a concern that with increasing age and comorbidities, there is higher anaesthetic risk, as well as peri-operative morbidity and mortality from pituitary surgery. This study aimed to audit the benefits and complications of transsphenoidal surgery performed in a large pituitary centre in elderly patients. METHODS: Data on all elderly patients (age: ≥ 70 years) undergoing transsphenoidal surgery at a large tertiary referral centre between November 2003 and August 2012 were collected retrospectively. RESULTS: A total of 104 operations were performed on 102 patients during 106 months. Median age was 75.2 years (range: 70-94) and 63 (61%) of the patients were male. Median follow-up was 15.2 months (range: 2.3-84.4). The majority presented with either peripheral visual field defects (26.4%) or pituitary hormone deficits (17.9%). A significant number (21.7%) of tumours were incidental radiological findings while investigating other diagnoses like stroke and dementia. 48.1% of operations were undertaken microscopically and the remaining 51.9% were endoscopic. Median hospital stay was 4 days (range: 3-18). Intra-operative complications included hypotension (1.9%) and blood loss requiring transfusion (2.9%). The 30-day complications included transient diabetes insipidus (9.6%), syndrome of inappropriate anti-diuretic hormone secretion (8.7%), delayed cerebrospinal fluid leak requiring lumbar drainage (0.9%) with no patient requiring formal repair. There were no peri-operative deaths. Long-term assessment suggested 79% had improved or stable endocrine function with 7% achieving biochemical cure and 91% showed improved or stable visual fields. CONCLUSIONS: Pituitary surgery in the elderly, whether microscopic or endoscopic, has low morbidity and mortality and is a safe and effective intervention for both symptom control and functional outcomes. |
| first_indexed | 2024-03-07T05:34:03Z |
| format | Journal article |
| id | oxford-uuid:e33fbb2d-db02-494c-b7ac-86a2b0a5e7ef |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:34:03Z |
| publishDate | 2014 |
| publisher | Informa Healthcare |
| record_format | dspace |
| spelling | oxford-uuid:e33fbb2d-db02-494c-b7ac-86a2b0a5e7ef2022-03-27T10:07:45ZTranssphenoidal pituitary surgery in the elderly is safe and effective.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e33fbb2d-db02-494c-b7ac-86a2b0a5e7efEnglishSymplectic Elements at OxfordInforma Healthcare2014Pereira, EPlaha, PChari, AParanathala, MHaslam, NRogers, AKorevaar, TTran, DOlarinde, RKaravitaki, NGrossman, ABCudlip, SAOBJECT: With an increasingly ageing population, the number of elderly people diagnosed with pituitary tumours continues to rise. There is a concern that with increasing age and comorbidities, there is higher anaesthetic risk, as well as peri-operative morbidity and mortality from pituitary surgery. This study aimed to audit the benefits and complications of transsphenoidal surgery performed in a large pituitary centre in elderly patients. METHODS: Data on all elderly patients (age: ≥ 70 years) undergoing transsphenoidal surgery at a large tertiary referral centre between November 2003 and August 2012 were collected retrospectively. RESULTS: A total of 104 operations were performed on 102 patients during 106 months. Median age was 75.2 years (range: 70-94) and 63 (61%) of the patients were male. Median follow-up was 15.2 months (range: 2.3-84.4). The majority presented with either peripheral visual field defects (26.4%) or pituitary hormone deficits (17.9%). A significant number (21.7%) of tumours were incidental radiological findings while investigating other diagnoses like stroke and dementia. 48.1% of operations were undertaken microscopically and the remaining 51.9% were endoscopic. Median hospital stay was 4 days (range: 3-18). Intra-operative complications included hypotension (1.9%) and blood loss requiring transfusion (2.9%). The 30-day complications included transient diabetes insipidus (9.6%), syndrome of inappropriate anti-diuretic hormone secretion (8.7%), delayed cerebrospinal fluid leak requiring lumbar drainage (0.9%) with no patient requiring formal repair. There were no peri-operative deaths. Long-term assessment suggested 79% had improved or stable endocrine function with 7% achieving biochemical cure and 91% showed improved or stable visual fields. CONCLUSIONS: Pituitary surgery in the elderly, whether microscopic or endoscopic, has low morbidity and mortality and is a safe and effective intervention for both symptom control and functional outcomes. |
| spellingShingle | Pereira, E Plaha, P Chari, A Paranathala, M Haslam, N Rogers, A Korevaar, T Tran, D Olarinde, R Karavitaki, N Grossman, AB Cudlip, SA Transsphenoidal pituitary surgery in the elderly is safe and effective. |
| title | Transsphenoidal pituitary surgery in the elderly is safe and effective. |
| title_full | Transsphenoidal pituitary surgery in the elderly is safe and effective. |
| title_fullStr | Transsphenoidal pituitary surgery in the elderly is safe and effective. |
| title_full_unstemmed | Transsphenoidal pituitary surgery in the elderly is safe and effective. |
| title_short | Transsphenoidal pituitary surgery in the elderly is safe and effective. |
| title_sort | transsphenoidal pituitary surgery in the elderly is safe and effective |
| work_keys_str_mv | AT pereirae transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT plahap transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT charia transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT paranathalam transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT haslamn transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT rogersa transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT korevaart transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT trand transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT olarinder transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT karavitakin transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT grossmanab transsphenoidalpituitarysurgeryintheelderlyissafeandeffective AT cudlipsa transsphenoidalpituitarysurgeryintheelderlyissafeandeffective |