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Transsphenoidal Surgery for Prolactinomas

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Transsphenoidal Surgery

Abstract

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.

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Authors and Affiliations

  1. Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Won Kim MD, Srinivas Chivukula MD & Marvin Bergsneider MD

  2. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Anthony Heaney MD PhD

  3. Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Marilene Wang MD

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  1. Won Kim MD
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  2. Srinivas Chivukula MD
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  3. Anthony Heaney MD PhD
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  4. Marilene Wang MD
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  5. Marvin Bergsneider MD
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Correspondence to Won Kim MD .

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Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

Electronic Supplementary Material

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

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Kim, W., Chivukula, S., Heaney, A., Wang, M., Bergsneider, M. (2017). Transsphenoidal Surgery for Prolactinomas. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_26

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