Surgical indications and outcomes of the endoscopic endonasal approach for brain tumors in older adults in Korea: a retrospective study

Objectives: This study explored the surgical indications for pituitary adenomas (PAs) in older patients by analyzing the outcomes of the transsphenoidal approach (TSA). Material and Methods: We retrospectively analyzed patients aged 65 years or older who underwent TSA from March 2020 to October 2023. We evaluated the preoperative and postoperative neurological and endocrinological features, degree of tumor resection, and perioperative complications. Results: In total, 134 patients aged 65 years or older (20.5%; 70 men and 64 women) underwent TSA (70-74 years: 48 patients, 75-79 years: 14 patients, ≥80 years: 8 patients). Among the 102 PAs, nonfunctioning PAs (NF-PAs) were the most common subtype (n= 96, 94.1%), and overall gross total resection was achieved in 89 (87.3%) patients. Intraoperative cerebrospinal fluid (CSF) leakage occurred in 32 of 102 patients with PAs; however, none of those patients experienced postoperative CSF leakage. In the NF-PA group, endocrinological function improved in 11 (12.6%) patients and worsened in four (4.6%). Preoperative visual field defects were present in 71 (74.6%) patients; 48 (67.6%) of them improved, and 5 (7.0%) worsened. Meningiomas were grossly resected in four of the eight patients, and four of the six patients with visual field defects experienced improvement. One patient had postoperative CSF leakage. Craniopharyngiomas were resected in six of eight patients, including two with recurrent tumors. Conclusion: TSA was safe in patients older than 65 years. However, unpredictable adverse effects could occur. Judicious decisions regarding surgical indications based on the natural history of the tumor subtypes and life expectancy are essential.