Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California.
Division of Endocrinology, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California.
Oper Neurosurg (Hagerstown). 2019 Mar 1;16(3):302-309. doi: 10.1093/ons/opy109.
Transsphenoidal surgery (TSS) for pituitary adenomas (PAs) is performed on elderly patients with increasing frequency. More research is necessary to assess the risk factors that are associated with TSS in an aging population.
To perform a retrospective study on postoperative safety outcomes following TSS in the elderly population stratified by decade of life.
A retrospective chart review of the USC Pituitary Database was conducted to identify patients ≥70 yr, who underwent TSS for PAs between 1995 and 2017. Surgical outcomes were analyzed in elderly (≥70 yr) vs nonelderly (<70 yr) patients. Elderly patients were additionally stratified according to age 70 to 79 vs ≥80 yr.
The cohorts included 115 elderly patients (70-79 yr: 94 patients; ≥80 yr: 21 patients) and 770 nonelderly patients. Elderly patients presented with more vision loss (62% vs 38%, P < .0001), dizziness (17% vs 6%, P = .0001) and altered mental status (7.3% vs 3%, P = .0451). Overall rates of surgical, medical, and endocrine complications were similar; however, elderly patients had significantly higher rates of postoperative hyponatremia (9.3% vs 4.7%, P = .0401) and lower rates of transient diabetes insipidus (0.9% vs 7.9%, P = .0038). Patients ≥ 80 yr had significantly more surgical complications (26.3%) compared to the 70 to 79 group (7.87%; P = .021) and <70 group (12.5%; P = .04).
Patients >70 yr are appropriate surgical candidates for TSS given the similar safety outcomes as younger patients. Given the higher propensity for surgical complications; however, a higher level of operative selectivity should be maintained in octogenarian patients.
经蝶窦手术（TSS）治疗垂体腺瘤（PA）在老年患者中的应用频率越来越高。为了评估与老龄化人口相关的 TSS 风险因素，需要进行更多的研究。
对 20 世纪 90 年代至 2017 年间在南加州大学垂体数据库中接受 TSS 治疗的老年患者进行回顾性研究，按十年进行分组，分析 TSS 术后的安全性结果。
对南加州大学垂体数据库进行回顾性图表审查，以确定 1995 年至 2017 年间接受 TSS 治疗的年龄≥70 岁的患者。分析老年（≥70 岁）与非老年（<70 岁）患者的手术结果。老年患者还根据年龄分为 70-79 岁和≥80 岁。
研究队列包括 115 名老年患者（70-79 岁：94 名；≥80 岁：21 名）和 770 名非老年患者。老年患者视力丧失（62%比 38%，P<0.0001）、头晕（17%比 6%，P=0.0001）和精神状态改变（7.3%比 3%，P=0.0451）的发生率更高。手术、医疗和内分泌并发症的总体发生率相似；然而，老年患者术后低钠血症的发生率明显更高（9.3%比 4.7%，P=0.0401），暂时性尿崩症的发生率明显更低（0.9%比 7.9%，P=0.0038）。≥80 岁的患者与 70-79 岁组（7.87%；P=0.021）和<70 岁组（12.5%；P=0.04）相比，手术并发症发生率显著更高（26.3%）。
鉴于与年轻患者相似的安全性结果，年龄>70 岁的患者是 TSS 的合适手术候选者。然而，由于手术并发症的发生率更高，应在 80 岁以上的患者中保持更高的手术选择性。
