Clinical efficacy of surgical treatment for pituitary prolactinomas

QIN Han; QIN Hailin; HU Junming

doi:10.13798/j.issn.1009-153X.2025.11.004

Abstract：Objective To investigate the clinical efficacy of surgical treatment for pituitary prolactinomas.Methods A retrospective analysis was conducted on the clinical data of 41 patients with pituitary prolactinomas who under-went transsphenoidal surgery in the Department of Neurosurgery,Central Theater General Hospital,from January 2014 to March 2024.Initial efficacy at 1 week postoperatively and long-term efficacy at 1 year postoperatively were assessed based on serum prolactin levels,MRI findings,and clinical symptom improvement.Results Among the patients,32 underwent microscopic transsphenoidal surgery,7 underwent endoscopic transsphenoidal surgery,and 2 with Knosp grade Ⅳ tumors underwent mi-croscopic pterional approach surgery.Gross total resection was achieved in 30 cases(73.2%),and subtotal resection in 11 cases(26.8%).For initial efficacy:complete remission was observed in 15 cases(36.6%),including 3 microadenomas(100%)and 12 non-invasive macroadenomas(63.2%);partial remission in 8 cases(19.5%);and no response in 18 cases(43.9%).For long-term efficacy:complete remission was achieved in 24 cases(58.5%),and recurrence occurred in 5 cases(12.2%).Postoperative com-plications included transient diabetes insipidus in 9 cases(21.9%),pituitary insufficiency in 8 cases(19.5%),and cerebrospinal fluid rhinorrhea in 1 case(2.4%).There were no surgical mortalities.Conclusion Transsphenoidal surgery(microscopic or endoscopic)yields high clinical symptom and endocrine remission rates for microadenomas and non-invasive macroadenomas of pituitary prolactinomas.It is particularly suitable for patients who are unresponsive to medication,intolerant to drugs,or have visual impairment.When surgical indications are strictly followed and the procedure is selectively performed in experienced medical centers,surgery serves as an important supplement to pharmacological therapy.