Transsphenoidal Surgery for Prolactinomas

  • Won KimEmail author
  • Srinivas Chivukula
  • Anthony Heaney
  • Marilene Wang
  • Marvin Bergsneider


Dopamine agonist therapy is considered first-line treatment for the great majority of prolactinomas. Although highly effective in normalizing serum prolactin levels and reducing tumor size, in clinical practice, a significant proportion of patients may ultimately choose transsphenoidal surgery. Indications include dopamine agonist resistance, intolerance as a result of side effects or adverse reactions, severe apoplexy, cerebrospinal fluid leak, and patient preference. In all cases, the goal is cure: in terms of both tumor resection and restoration of endocrine function. Patient selection is paramount to achieving this goal. Patients with localized tumor without extension outside the sella or into neighboring structures have been shown to have greater rates of normoprolactinemia following surgical extirpation. Moreover, those that are treated at dedicated pituitary centers by surgeons that specialize in pituitary surgery also enjoy greater rates of remission following operative treatment. Closer consideration of the surgical prolactinoma population as a heterogeneous patient set with individual tumor and patient characteristics that may prognosticate who will respond best to transsphenoidal surgery will aid patient counseling and surgical decision making in the future.


Prolactinoma Surgery Operative Indications Prognostic Indicators 

Supplementary material

Video 26.1

Surgical demonstration of pseudocapsular resection technique for an endoscopic, endonasal resection of a prolactin-secreting macroadenoma (MOV 220657 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Won Kim
    • 1
    Email author
  • Srinivas Chivukula
    • 1
  • Anthony Heaney
    • 2
  • Marilene Wang
    • 3
  • Marvin Bergsneider
    • 1
  1. 1.Department of NeurosurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of Head and Neck SurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA

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