Introduction Renewed interest in transsphenoidal surgery (TSS) as a therapeutic option for prolactinomas has emerged. This study is aimed at defining the current role of pituitary surgery in the management of prolactinomas. Materials and Methods In this retrospective, consecutive single-center study, 162 patients who underwent primary microscopic TSS for prolactinomas between 2006 and 2019 were analyzed regarding surgical indication, previous dopamine-agonist (DA) treatment, early remission rates (3 months postoperatively), surgical complications and pituitary function. Results Seventy-four microprolactinomas and 88 macroprolactinomas were operated by TSS. 62.3% of the patients had received prior DA treatment. For microprolactinomas, the predominant indication for surgery was patient’s wish (41.9%), while indications for macroprolactinomas varied. For enclosed microprolactinomas, the initial remission rate was 92.1%, while for macroprolactinomas, the rate was 70.4%. No significant difference of remission rates was found between DA-pretreated (65.3%) and non-pretreated (72.1%) patients (p=0.373).None of the patients suffered a significant complication. Re-operation for a postoperative cerebrospinal fluid leak was required in one patient (0.6%). Permanent postoperative deterioration of pituitary function was only observed in one of 158 patients with surgery for a prolactinoma (0.6%). Improvement of pituitary function was observed in 8 of 25 patients (32%) with preoperative deficits. Conclusion Transsphenoidal microsurgery is safe and efficient for treatment of prolactinomas. It is particularly suitable for enclosed prolactinomas. The patient should be well informed of the pros and cons of the treatment options, which include DA medication and TSS, and the patient’s preference should be taken into account during decision-making.

中文翻译：

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经蝶窦显微手术治疗泌乳素瘤的结果——当代系列 162 例

介绍 对经蝶窦手术 (TSS) 作为催乳素瘤的治疗选择的新兴趣已经出现。本研究旨在确定垂体手术在治疗泌乳素瘤中的当前作用。材料和方法 在这项回顾性、连续性单中心研究中，对 2006 年至 2019 年间因泌乳素瘤接受原发性显微 TSS 的 162 名患者的手术指征、既往多巴胺激动剂 (DA) 治疗、早期缓解率（术后 3 个月）、手术并发症和垂体功能。结果 74 例微泌乳素瘤和 88 例巨泌乳素瘤采用 TSS 手术。62.3% 的患者曾接受过 DA 治疗。对于微泌乳素瘤，手术的主要适应症是患者的意愿（41.9%），而巨泌乳素瘤的适应症则各不相同。对于封闭的微泌乳素瘤，初始缓解率为 92.1%，而对于大泌乳素瘤，缓解率为 70.4%。DA预处理（65.3%）和未预处理（72.1%）患者的缓解率无显着差异（p=0.373）。无一例患者出现明显并发症。一名患者（0.6%）因术后脑脊液漏需要再次手术。仅在 158 名接受催乳素瘤手术的患者中观察到 1 名术后垂体功能永久性恶化 (0.6%)。在 25 名术前缺陷患者中有 8 名 (32%) 观察到垂体功能的改善。结论经蝶窦显微手术治疗泌乳素瘤安全有效。它特别适用于封闭的泌乳素瘤。