Endoscopic Transnasal Approach for Microprolactinomas with Experience of 105 Cases in a Single Center: Paradigmal Shift for Conventional Medical Therapy.

Uzuner A., Yilmaz E., Caklili M., Selek A., Aydemir F., Cabuk B., ...Daha Fazla

World neurosurgery, cilt.170, 2023 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 170
  • Basım Tarihi: 2023
  • Doi Numarası: 10.1016/j.wneu.2022.12.003
  • Dergi Adı: World neurosurgery
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, EMBASE, Index Islamicus, MEDLINE, Veterinary Science Database
  • Anahtar Kelimeler: agonists, Dopamine agonists, Endoscopic transsphenoidal surgery, Microprolactinoma, Recurrence, COST-EFFECTIVENESS ANALYSIS, DOPAMINE AGONISTS, TRANSSPHENOIDAL SURGERY, PITUITARY-ADENOMAS, PROLACTINOMAS, CABERGOLINE, HYPERPROLACTINEMIA, PREVALENCE, MANAGEMENT, DIAGNOSIS
  • Kocaeli Üniversitesi Adresli: Evet

Özet

-OBJECTIVE: The classically recommended first-line ther-apy for microprolactinomas is medical therapy. In the pres-ence of drug resistance and intolerance after the use of dopamine agonists or when the patients prefer surgery instead of medication, surgical treatment is considered as second-line treatment. The high hormonal remission and low complication rates after surgery for microprolactinomas suggest that the surgical outcome of endoscopic surgeries may be better than medical therapy in well-selected pa-tients. This study reports a large series of patients with microprolactinoma treated by endoscopic transnasal approach and evaluates the efficiency of surgical treatment.-METHODS: Our study is a retrospective cohort analysis of patients with microprolactinoma operated on by an endoscopic transnasal approach between August 1997 and February 2022 by an experienced pituitary surgeon in a single tertiary center. Inclusion criteria for micro-prolactinoma were based on increased prolactin levels, microadenoma (<10 mm in diameter) on pituitary magnetic resonance imaging, and histopathologically verified lac-totroph adenoma.-RESULTS: The mean follow-up was 74.90 months (range, 6-207). The postoperative day 1 remission rate was 85.7% and the long-term remission rate was 74.3%. The long-term remission rates of the patients in the preference group were significantly higher than those of the patients in the resistant or intolerance group (P = 0.002). Patients who used dopamine agonists for more than 3 years had a lower remission rate compared with patients who used dopamine agonists for a shorter period or who did not use it (P = 0.01). The surgical complication rate was 4.76%. -CONCLUSIONS: According to our findings, endoscopic transnasal surgery performed by an experienced neuro-surgeon in well-selected patients with microprolactinoma can be offered with cure rates superior to medical therapy and may be an alternative first-line treatment option to dopamine agonists.