When the patient’s family handed over the imaging scans, they immediately asked whether surgery was feasible for an 80-year-old patient. The scans clearly showed a sellar pituitary adenoma compressing the optic chiasm, and the patient’s vision had already started to deteriorate. If left untreated for another few months, permanent blindness would likely develop.

I told them surgery was an option. It would not require a craniotomy; instead, minimally invasive transsphenoidal surgery would be performed through the nasal cavity. There would be no external incisions, and no need to retract brain tissue. Surgical instruments are advanced through the sphenoid sinus to remove the tumor. This approach results in minimal blood loss and imposes far less physical strain on elderly patients compared with craniotomy.

The family then asked about surgical risks. I explained that the inherent risks of the procedure are manageable, yet thorough preoperative cardiac and pulmonary function tests are mandatory. Surgery can only proceed if the heart and lungs can tolerate general anesthesia. Eligibility is determined by overall physical condition rather than chronological age, and a definitive treatment plan can only be made after completing all required examinations and comprehensive evaluation.

Subsequent test results revealed the patient had acceptable cardiac and pulmonary function, with no severe uncontrolled underlying chronic illnesses. Transsphenoidal surgery was scheduled accordingly. The patient stayed in the intensive care unit for one night after the operation and was transferred to a regular ward the next day. No cerebrospinal fluid leakage occurred, and vision did not worsen further. Within a few days, the elderly patient was able to get out of bed and walk, greatly relieving the family’s anxiety.

For elderly patients with pituitary adenomas, transnasal minimally invasive surgery represents one of the least traumatic treatment options. Without surgical intervention, ongoing optic nerve compression by the tumor may lead to irreversible vision loss. The decision to operate should not be based solely on age, but on whether there remains a viable chance to preserve visual function.