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Updated: Jun 13, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Outcomes in surgical management of microprolactinomas: an international multi-institutional series
Danielle Golub1,2, Timothy G White3, Harshal A Shah3
1Department of Neurosurgery, Northwell Health, Manhasset, NY, USA. Dgolub1@northwell.edu.
Background:
Prolactinomas represent the most common pituitary adenoma subtype, the majority of which are microprolactinomas. Dopamine agonists (DAs) remain the first-line intervention for microprolactinomas, however, many patients either cannot tolerate DAs or require lifelong therapy to maintain hormonal control. As endoscopic endonasal surgery (EES) continues to revolutionize the surgical management of sellar lesions, we sought to reassess the feasibility and efficacy of early surgical resection for microprolactinoma.
Methods:
Retrospective chart review from 2010 to 2021 of adults who underwent EES for microprolactinoma was performed across three medical centers. Surgical failure was defined as a need to restart DAs, a serum prolactin level greater than 30ng/mL at last follow-up, tumor recurrence, or a need for reoperation.
Results:
A total of 56 patients were identified with a mean age of 32.9 years and an average of 26.4 months of follow-up. The majority had been on DAs preoperatively (98.2%). The most common surgical indications were DA intolerance (73.2%), tumor unresponsiveness (19.6%), and desire for pregnancy (7.1%). Gross total resection was achieved in 51 (91.1%) cases. The overall surgical remission rate was approximately 70% with failures observed in 17 (30.4%) patients. Multivariate logistic regression identified subtotal resection as the only independent predictor of surgical failure (p = 0.038*). The most common postoperative complication was transient arginine vasopressin deficiency (AVP-D) (21.4%). There were no cases of permanent AVP-D, new visual deficits, or cerebrospinal fluid leak.
Conclusions:
With a surgical remission rate of nearly 70%, EES represents a safe and viable alternative strategy to long-term DA treatment for microprolactinomas.
Insights
Endoscopic endonasal surgery (EES) offers a viable alternative to dopamine agonists for microprolactinoma treatment. This approach achieved a nearly 70% remission rate, demonstrating its efficacy and safety for pituitary adenomas.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Prolactinomas, the most common pituitary adenomas, are typically treated with dopamine agonists (DAs).
- Many patients experience DA intolerance or require lifelong therapy.
- Endoscopic endonasal surgery (EES) is an evolving technique for sellar lesions.
Purpose of the Study:
- To evaluate the feasibility and efficacy of early surgical resection for microprolactinoma using EES.
- To compare EES outcomes with traditional DA therapy.
Main Methods:
- Retrospective chart review of 56 adult patients who underwent EES for microprolactinoma between 2010-2021 across three centers.
- Surgical failure defined by need for DAs, prolactin >30ng/mL, recurrence, or reoperation.
- Multivariate logistic regression analyzed predictors of surgical failure.
Main Results:
- Gross total resection achieved in 91.1% of patients.
- Overall surgical remission rate was approximately 70%, with 30.4% experiencing failure.
- Subtotal resection was the only independent predictor of surgical failure (p=0.038).
- Transient arginine vasopressin deficiency (AVP-D) was the most common complication (21.4%), with no permanent AVP-D, visual deficits, or CSF leaks.
Conclusions:
- EES provides a safe and effective alternative to long-term DA treatment for microprolactinomas.
- A nearly 70% surgical remission rate supports EES as a viable therapeutic option.
- Early surgical intervention should be considered for select microprolactinoma patients.
