Transsphenoidal Microsurgical Therapy of Prolactinomas: Initial Outcomes and Long-term Results

Transsphenoidal Microsurgical Therapy of Prolactinomas: Initial Outcomes and Long-term Results AbstractOBJECTIVE:Prolactinomas are frequently treated primarily with dopamine agonists; however, these agents have disadvantages and require life-long therapy. We therefore reassessed transsphenoidal microsurgery as an alternativetherapy.METHODS:We reviewed the data for 121 female patients treated surgically for prolactinomas between 1976 and 1979 (Group 1) and 98 patients treated between 1988 and 1992 (Group 2).RESULTS:Of 219 women, 92% with preoperative prolactin (PRL) values of ^100 ng/ml and 91% with intrasellar microadenomas experienced initial remission; 80 to 88% of patients with intrasellar macroadenomas or macroadenomas showing moderate suprasellar extension or focal sphenoid sinus invasion experienced remission. Women with PRL values of >200 ng/ml and those with larger and more invasive adenomas experienced poorer outcomes (37-41 % remission). Lower preoperative PRL values and adenoma stage were the best predictors of initial surgical outcomes. At the most recent evaluations, 89% of women who experienced initial remission continued to experience clinical remission; 85% exhibited normal PRL values, and 5% demonstrated mild, asymptomatic, recurrent hyperprolactinemia (PRL values of <34 ng/ml). In Group 1, 84% of patients continued to experience remission (82% with normal PRL values) after a median follow-up period of 15.6 years. In Group 2, 97% of patients continued to experience remission (88% with normal PRL values) after a median follow-up period of 3.2 years. Lower postoperative PRL values were the best predictors of long-term remission.CONCLUSION:Transsphenoidal microsurgery is an effective alternative to long-term medical therapy for selected patients with prolactinomas. Successful outcomes and long-term remission were achieved in patients with microadenomas and noninvasive macroadenomas. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Transsphenoidal Microsurgical Therapy of Prolactinomas: Initial Outcomes and Long-term Results

Transsphenoidal Microsurgical Therapy of Prolactinomas: Initial Outcomes and Long-term Results

Transsphenoidal Microsurgical Therapy of Prolactinomas: Initial Outcomes and Long-term Results J. Blake Tyrrell, M .D ., Kathleen R. Lamborn, Ph.D., Lisa T. Hannegan, R.N., M.S., Carol B. Applebury, R.N., M.S., Charles B. Wilson, M .D . Departments of M edicine (JBT) and Neurological Surgery (KRL, L T H , C B A , C B W ) and the Metabolic Research Unit (JBT), University of California, San Francisco, San Francisco, California O B JE C T IV E : Prolactinomas are frequently treated primarily with dopamine agonists; however, these agents have disadvantages and require life-long therapy. W e therefore reassessed transsphenoidal m icrosurgery as an alter­ native therapy. M E T H O D S : W e reviewed the data for 121 female patients treated surgically for prolactinom as between 1976 and 1979 (Group 1 ) and 98 patients treated between 1988 and 1992 (Group 2). RESULTS: O f 219 women, 9 2 % with preoperative prolactin (PRL) values of ^ 1 0 0 ng/ml and 9 1 % with intrasellar microadenomas experienced initial remission; 80 to 88% of patients with intrasellar m acroadenom as or mac­ roadenomas showing moderate suprasellar extension or focal sphenoid sinus invasion experienced remission. Women with PRL values of > 2 0 0 ng/ml and those with larger and more invasive adenomas experienced poorer outcomes (37-41 % remission). Lower preoperative PRL values and adenoma stage w ere the best predictors of initial surgical outcomes. At the most recent evaluations, 8 9 % of women who experienced initial remission continued to experience clinical remission; 8 5 % exhibited normal PRL values, and 5 % demonstrated mild, asymptomatic, recurrent hyperprolactinemia (PRL values of < 3 4 ng/ml). In G roup 1, 8 4 % of patients continued to experience remission (8 2 % with normal PRL values) after a median follow-up period of 15.6 years. In Group 2, 9 7 % of patients continued to experience remission (88% with normal PRL values) after a median follow-up period of 3.2 years. Lower...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199902000-00006
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:Prolactinomas are frequently treated primarily with dopamine agonists; however, these agents have disadvantages and require life-long therapy. We therefore reassessed transsphenoidal microsurgery as an alternativetherapy.METHODS:We reviewed the data for 121 female patients treated surgically for prolactinomas between 1976 and 1979 (Group 1) and 98 patients treated between 1988 and 1992 (Group 2).RESULTS:Of 219 women, 92% with preoperative prolactin (PRL) values of ^100 ng/ml and 91% with intrasellar microadenomas experienced initial remission; 80 to 88% of patients with intrasellar macroadenomas or macroadenomas showing moderate suprasellar extension or focal sphenoid sinus invasion experienced remission. Women with PRL values of >200 ng/ml and those with larger and more invasive adenomas experienced poorer outcomes (37-41 % remission). Lower preoperative PRL values and adenoma stage were the best predictors of initial surgical outcomes. At the most recent evaluations, 89% of women who experienced initial remission continued to experience clinical remission; 85% exhibited normal PRL values, and 5% demonstrated mild, asymptomatic, recurrent hyperprolactinemia (PRL values of <34 ng/ml). In Group 1, 84% of patients continued to experience remission (82% with normal PRL values) after a median follow-up period of 15.6 years. In Group 2, 97% of patients continued to experience remission (88% with normal PRL values) after a median follow-up period of 3.2 years. Lower postoperative PRL values were the best predictors of long-term remission.CONCLUSION:Transsphenoidal microsurgery is an effective alternative to long-term medical therapy for selected patients with prolactinomas. Successful outcomes and long-term remission were achieved in patients with microadenomas and noninvasive macroadenomas.

Journal

NeurosurgeryOxford University Press

Published: Feb 1, 1999

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