[Transsphenoidal approach to prolactinomas]

Transeptal transsphenoidal surgery for pituitary tumors is a well established surgical technique. In particular the use of medical treatment in patient with prolactinomas has induced the control of hiperprolactinemia and the shrinkage of the tumor in the great majority of the patients, for that reason the treatment of the prolactinomas is controversial.

We evaluate the results of transsphenoidal microsurgical treatment of prolactin secreting adenomas at our Unit.

We made a retrospective analysis of 63 patients operated on via transsphenoidal microsurgical technique for prolactin secreting adenomas between 1996 and 2003. Age, sex, symptoms, tumor size, hormonal levels, complications and postsurgical outcome were considered.

There was a female predominance of 86% of the cases and middle aged patients were more commonly seen. 31 patients had tumors more than 10mm in diameter on the CT scan. The most frecuent complication was transient diabetes insipidus (11 cases). Prolactin levels were reduced to non tumoral values in 90.6% of microadenomas (29 cases) and in 67.7% of macroadenomas (21 cases). Headache was the most frecuent complain in our patients with amelioration after surgery in 82% (36 cases). Campimetric visual defects were reduced in 69% (18 cases).

Transsphenoidal adenomectomy is a safe treatment option for patients with prolactin secreting adenomas with surgical indication.