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Endoscopic endonasal surgery for prolactinomas: prognostic factors for disease control and management of persistent disease

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Abstract

Only a limited number of studies have focused on the results of the Endoscopic Endonasal Approach (EEA) for treatment of prolactinomas. We sought to assess the effectiveness of EEA for prolactinoma surgery, identify factors for disease remission, and present our approach for the management of persistent disease. Forty-seven prolactinomas operated over 10 years, with a mean follow-up of 59.9 months, were included. The primary endpoints were early disease remission and remission at last follow-up. Resistance/intolerance to DA were surgical indications in 76.7%. Disease remission was achieved in 80% of microprolactinomas and 100% of microprolactinomas enclosed by the pituitary. Early disease remission was correlated with female gender (p=0.03), lower preoperative PRL levels (p=0.014), microadenoma (p=0.001), lack of radiological hemorrhage (p=0.001), absence of cavernous sinus (CS) invasion (p<0.001), and extent of resection (EOR) (p<0.001). Persistent disease was reported in 48.9% of patients, with 47% of them achieving remission at last follow-up with DA therapy alone. Repeat EEA and/or radiotherapy were utilized in 6 patients, with 66.7% achieving remission. Last follow-up remission was achieved in 76.6%, with symptomatic improvement in 95.8%. Factors predicting last follow-up remission were no previous operation (p=0.001), absence of CS invasion (p=0.01), and EOR (p<0.001). Surgery is effective for disease control in microprolactinomas. In giant and invasive tumors, it may significantly reduce the tumor volume. A multidisciplinary approach may lead to long-term disease control in three-quarters of patients, with symptomatic improvement in an even greater proportion.

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Author notes

  1. Drs. Fred Gentili and Pablo F. Recinos are equal co-senior authors.

Authors and Affiliations

  1. Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Aristotelis Kalyvas, Farshad Nassiri, Ruth Lau, Philip J O’Halloran, Nilesh Mohan, Thomas Wälchli, Vincent C. Ye, Gelareh Zadeh & Fred Gentili

  2. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

    Joao Paulo Almeida

  3. Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Dennis M. Tang

  4. Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Pranay Soni, Varun R. Kshettry & Pablo F. Recinos

  5. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Tamia Potter

  6. Endocrine Oncology Site, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada

    Shereen Ezzat

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  1. Aristotelis Kalyvas
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Contributions

Aristotelis Kalyvas: conceptualization, methodology, investigation, writing—original draft, writing—review and editing, visualization, supervision. Joao Paulo Almeida: conceptualization, methodology, investigation, writing—review and editing. Farshad Nassiri: validation, formal analysis, resources, writing—review and editing. Ruth Lau: investigation, writing—review and editing. Philip J O’Halloran: investigation, writing—review and editing. Nilesh Mohan: investigation, writing—review and editing. Thomas Waelchi: investigation, writing—review and editing. Vincent C. Ye: investigation, writing—review and editing. Dennis M. Tang: validation, writing—review and editing. Pranay Soni: validation, writing—review and editing. Tamia Potter: validation, investigation. Shereen Ezzat: resources, writing—review and editing. Varun R. Kshettry: resources, writing—review and editing. Gelareh Zadeh: resources, writing—review and editing. Pablo F. Recinos: resources, writing—review and editing, supervision. Fred Gentili: resources, writing—review and editing, supervision

Corresponding author

Correspondence to Aristotelis Kalyvas.

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Competing interests

Pablo Recinos is a consultant for Stryker, and Varun Kshettry is a consultant for Stryker and Integra LifeSciences. The aforementioned disclosures are not relevant to this work. The rest of the authors report no competing interests regarding the materials or methods used in this study or the findings specified in this paper.

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Kalyvas, A., Almeida, J.P., Nassiri, F. et al. Endoscopic endonasal surgery for prolactinomas: prognostic factors for disease control and management of persistent disease. Neurosurg Rev 46, 295 (2023). https://doi.org/10.1007/s10143-023-02199-7

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