Transsphenoidal microsurgical results of female patients with prolactinomas

Objective: We investigated surgical cure rate and surgical complications of patients with macroprolactinomas who desired pregnancy to evaluate the efficacy of transsphenoidal surgery. Methods: Surgical cure rate was investigated in 138 female patients who were under 40 years old. Results: We found a significant correlation between serum prolactin levels and adenoma volume (r = 0.004; p < 0.0001), adenoma volume and age (r = -0.213; p < 0.03), and proliferative index of the adenoma and age (r = -0.15; p < 0.007). Seventy-seven out of 81 patients with enclosed macroadenoma were considered cured, and therefore the overall surgical cure rate was 95%. However, during long-term follow-up, recurrence of adenomas with hyperprolactinemia was seen in 5 out of 81 patients (6%), and the long-term cure rate in patients with enclosed macroadenomas was 89%. Adenomas that did not invade the cavernous sinus showed a significantly higher surgical curability and lower serum prolactin levels, and a smaller size than those adenomas that invaded the cavernous sinus. Conclusions: The long-term surgical cure rate was found to be 89% and this success rate far surpasses the complication rate of 39% during pregnancy by dopamine agonist therapy. Thus, transsphenoidal surgery should be considered as a first-line treatment for female patients who desire pregnancy.