Transsphenoidal Microsurgical Therapy of Prolactinomas: Initial Outcomes and Long-term Results
作者:
J.,
Tyrrell Kathleen,
Lamborn Lisa,
Hannegan Carol,
Applebury Charles,
期刊:
Neurosurgery
(OVID Available online 1999)
卷期:
Volume 44,
issue 2
页码: 254-261
ISSN:0148-396X
年代: 1999
出版商: OVID
关键词: Bromocriptine;Dopamine agonists;Pituitary adenomas;Prolactin;Prolactinoma;Transsphenoidal microsurgery
数据来源: OVID
摘要:
OBJECTIVE:Prolactinomas are frequently treated primarily with dopamine agonists; however, these agents have disadvantages and require life-long therapy. We therefore reassessed transsphenoidal microsurgery as an alternative therapy.METHODS:We reviewed the data for 121 female patients treated surgically for prolactinomas between 1976 and 1979 (Group 1) and 98 patients treated between 1988 and 1992 (Group 2).RESULTS:Of 219 women, 92% with preoperative prolactin (PRL) values of ≤100 ng/ml and 91% with intrasellar microadenomas experienced 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 and those with larger and more invasive adenomas experienced poorer outcomes (37-41% remission). Lower preoperative PRL values and adenoma stage were the best predictors of initial surgical outcomes. At the most recent evaluations, 89% of women who experienced initial remission continued to experience 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 normal 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 values) 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 long-term medical therapy for selected patients with prolactinomas. Successful outcomes and long-term remission were achieved in patients with microadenomas and noninvasive macroadenomas.
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