Are visual outcomes satisfactory after endoscopic endonasal transsphenoidal surgery in elderly patients with non-functioning pituitary adenomas?

Purpose Non-functioning pituitary adenomas (NFPA) in elderly patients may be followed conservatively because of a limited life expectancy, except when visual function is severely impaired. A decision to perform surgical intervention in these patients should be supported by favorable surgical and visual outcomes. Methods Data were analyzed for 130 patients with NFPA treated surgically since 2010. Patients aged ≥ 75 years (elderly group) were compared with non-elderly patients aged < 74 years regarding patient characteristics, tumor characteristics, surgical and visual outcomes, and preoperative visual function, including disease duration and ophthalmologic comorbidities. Results Visual impairment was highly prevalent in the 22 elderly patients with NFPA. However, postoperative visual improvement occurred in only 47.6% of these symptomatic patients, which was significantly poorer than that in non-elderly patients ( p  < 0.01). Furthermore, two of three patients who developed postoperative suprasellar hematoma after surgery experienced visual deterioration. In elderly patients, a high prevalence of ophthalmologic comorbidities and previous cataract surgery were associated with delayed surgery ( p  < 0.01). Additionally, patients aged 65–74 years had a higher prevalence of ophthalmologic comorbidities and preceding cataract surgery than patients aged < 64 years ( p  < 0.01). However, favorable postoperative visual outcomes and disease duration were not statistically different between the two non-elderly groups ( p  > 0.05). Conclusion Several issues are associated with visual outcomes when performing surgery in elderly patients with NFPAs. Early surgical intervention after the onset of visual symptoms due to NFPA is desirable, and particular care is necessary to avoid postoperative suprasellar hematoma.