Analysis of the efficacy of transnasal endoscopic surgery for pituitary prolactinomas
Zhang Yuan
Chen Yong
Zheng Xin
Zhang Xiaoqing
Yang Hui
Li Song
Abstract：Objective To investigate the clinical efficacy of transnasal endoscopic surgery for the treatment of patients with pituitary prolactinomas.Methods The clinical data of 47 patients with prolactinomas were analyzed retrospectively,and all of them received endoscopic transnasal surgery.All the patients were followed up for at least 6 months to compare the differences in surgical efficacy based on different tumor characteristics.Results Among the patients,there were 29 females(61.7%)and 18 males(38.3%),with a median age of 31 years and a median preoperative tumor diameter of 1.80 cm.According to the Knosp grade,there were 13 cases(27.66%)of grade 0,12 cases(25.53%)of grade 1,7 cases(14.89%)of grade 2,7 cases(14.89%)of grade 3,and 8 cases(17.02%)of grade 4.Preoperatively bromocriptine was taken in 28 cases,including 18 dopamine agonist-resistant patients(64.3%,18/28).The complete postoperative prolactin remission was 21 cases(44.7%).Postoperative complications included 3 cases of infection,4 cases of pituitary insufficiency and 2 cases of cerebrospinal fluid leak,and 2 deaths.Further subgroup analysis revealed that the imaging-confirmed total resection rates of different diameter tumors(0-2 cm group:25 cases,2-3 cm group 11 cases,>3cm group 11 cases)were 96%,63.4%,0%,and the endocrine remission rates were 76%,18.18%,and 0%,respectively.The endocrine remission rates in the 0-2cm group were significantly higher than those in the other two groups(P<0.001),and there were no post-operative infections,cerebrospinal fluid leaks,or pituitary function deficits.Based on whether the tumor invaded the cavernous sinus,the patients were divided into a non-invasive group(32 cases)and an invasive group(15 cases).The imaging-confirmed total resection rate was significantly higher in the non-invasive group(84.37%)than in the invasive group(26.67%)(P<0.001),and the endocrine remission rate was also significantly higher in the non-invasive group(62.5%)than in the invasive group(6.67%)(P<0.001).Additionally,the surgical duration and intraoperative blood loss were significantly reduced in the non-invasive group(P<0.05).Combined analysis of tumor diameter and invasiveness showed that the endocrine remission rate was significantly higher in the non-invasive 0-2cm group than in the 2-3cm group(P=0.009),with no significant differences in surgical duration,intraoperative blood loss,or imaging-confirmed total resection rate between the two groups.Further analysis of the efficacy of preoperative oral bromocriptine administration in combination with endoscopic endonasal surgery showed that,among patients in the non-invasive 0-2 cm group,the endocrine remission rate was lower in the preoperative medication group(73.33%)than in the non-medication group(88.89%),and the intraoperative blood loss was increased(P=0.016).Conclusions For non-invasive prolactinomas with tumor diameters less than 2 cm,endoscopic endonasal surgery has satisfactory surgical efficacy and no adverse surgical complications.The endoscopic endonasal surgery is expected to be a first-line therapeutic alternative to dopamine agonists for this type of prolactinomas.
Keywords：prolactinomaransanal endoscopic surgerynon-invasivetumor volumeefficacy
Publication Date：2024-10-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 572-578 )