The Role of Endoscopic Transsphenoidal Surgery in Microprolactinomas: A Retrospective Study.

Objective: Most patients with microprolactinomas require lifetime treatment with a dopamine agonist. Many patients in our center have sought endoscopic transsphenoidal surgery as an alternative therapy.

Methods: This study was a retrospective cohort analysis of 42 patients with microprolactinoma who underwent endoscopic transsphenoidal surgery between January 2010 and December 2023 performed by experienced neurosurgeons in our center.

Results: The mean follow-up duration was 30.17 months (range, 13.00-45.40 months). The short-term (postoperative day 1) remission rate was 95.24%, and the long-term (>1-year follow-up) remission rate was 92.86%. The pattern of prolactin level changes on postoperative day 1 was significantly associated with recurrence. In the hypoprolactinemia group, all 29 patients achieved remission at the 1-year follow-up. In patients with normal prolactin levels, 10 of 11 patients achieved remission, while 1 of 11 patients had recurrence at the 1-year follow-up. In the hyperprolactinemia group, 2 of 2 patients had recurrence at the 1-year follow-up. Moreover, adenoma location was significantly associated with recurrence. In the recurrent group (3 patients), 2 patients belonged to the uncertain group, while the third patient belonged to the lateral group. The surgical complications were temporary and resolved shortly after surgery.

Conclusions: According to our findings, endoscopic transsphenoidal surgery performed on patients with microprolactinomas at advanced pituitary tumor centers could be an option with high success rates and low complications. Moreover, improving magnetic resonance imaging techniques and/or multidisciplinary team discussion before surgery for microprolactinoma could improve tumor remission after surgery.