Transsphenoidal microsurgical therapy of prolactinomas: Initial outcomes and long-term results

OBJECTIVE: Prolactinomas are frequently treated primarily with dopamine ago nists; however, these agents have disadvantages and require life-long thera py. We therefore reassessed transsphenoidal microsurgery as an alternative therapy. METHODS: We reviewed the data for 121 female patients treated surgically fo r prolactinomas between 1976 and 1979 (Group 1) and 98 patients treated bet ween 1988 and 1992 (Group 2). RESULTS: Of 219 women, 92% with preoperative prolactin (PRL) values of less than or equal to 100 ng/ml and 91% with intrasellar microadenomas experien ced initial remission; 80 to 88% of patients with intrasellar macroadenomas or macroadenomas showing moderate suprasellar extension or focal sphenoid sinus invasion experienced remission. Women with PRL values of >200 ng/ml a nd those with larger and more invasive adenomas experienced poorer outcomes (37-41% remission). Lower preoperative PRL values and adenoma stage were t he best predictors of initial surgical outcomes. At the most recent evaluat ions, 89% of women who experienced initial remission continued to experienc e clinical remission; 85% exhibited normal PRL values, and 5% demonstrated mild, asymptomatic, recurrent hyperprolactinemia (PRL values of <34 ng/ml). In Group 1, 84% of patients continued to experience remission (82% with no rmal PRL values) after a median follow-up period of 15.6 years. In Group 2, 97% of patients continued to experience remission (88% with normal PRL val ues) after a median follow-up period of 3.2 years. Lower postoperative PRL values were the best predictors of long-term remission. CONCLUSION: Transsphenoidal microsurgery is an effective alternative to lon g-term medical therapy for selected patients with prolactinomas. Successful outcomes and long-term remission were achieved in patients with microadeno mas and noninvasive macroadenomas.