Present status of neurosurgery in the treatment of prolactinomas

Our experience with prolactinomas started in 1972 and is based on about 370 patients. Of these 247 were treated surgically, about 110 underwent medical therapy and a small number of patients were observed only. In microprolactinomas prolactin-levels could be normalized in up to 80% of the patients after selective adenomectomy. However, true recurrences were observed in 16% of the patients during long-term follow-up. The operative risk is rather low. There was no mortality in this series. The rate of complications is about 1%. Medical treatment with dopamine-agonists is successful especially in women who desire pregnancy, but should only be used in small microadenomas, in order to avoid complications. In larger macroprolactinomas h extra-sellar extension in whom primary surgical removal leads to a normalization of prolactin-levels in a minority of cases only primary therapy with dopamine-agonists leads to shrinkage of the tumour mass in about two-thirds of the patients. Since the tumour mass does not disappear completely after short-term medical treatment, we favour additional surgical tumour removal instead of long-lasting administration of dopamine-agonistic drugs in higher dosages.