Transsphenoidal pituitary surgery in the elderly is safe and effective

Br J Neurosurg. 2014 Oct;28(5):616-21. doi: 10.3109/02688697.2013.872225. Epub 2013 Dec 30.


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.

Keywords: adenoma; elderly; endoscopic; outcomes; pituitary; transsphenoidal adenohypophysectomy; tumour.

MeSH terms

  • Adenoma / surgery*
  • Aged
  • Aged, 80 and over
  • Endoscopy / methods
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Neurosurgical Procedures* / adverse effects
  • Pituitary Hormones / metabolism
  • Pituitary Neoplasms / surgery*
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Treatment Outcome


  • Pituitary Hormones