Department of Neurosurgery, Health Sciences University, Kartal Doktor Lütfi Kırdar City Hospital, Istanbul, Turkiye.
Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, Turkiye.
World Neurosurg. 2023 Jul;175:e1166-e1174. doi: 10.1016/j.wneu.2023.04.089. Epub 2023 Apr 27.
To investigate the initial and long-term remission rates, factors related to remission, secondary treatments, and outcomes for patients with prolactinoma who underwent endoscopic transsphenoidal surgery (ETSS).
The medical files of the 45 prolactinoma patients who underwent ETSS between 2015 and 2022 were retrospectively reviewed. Relevant demographic and clinical data were obtained.
Twenty-one (46.7%) patients were female. The median age of patients at ETSS was 35 (interquartile range, 22.5-50) years. The median clinical follow-up of patients was 28 (interquartile range 12-44) months. The initial surgical remission rate was 60%. Recurrence was detected in 7 patients (25.9%). Postoperative dopamine agonists were used in 25 patients, radiosurgery in 2, and second ETSS in 4 patients. After these secondary treatments, the long-term biochemical remission rate was 91.1%. The factors associated with failure in surgical remission are: male gender, older age, higher tumor size, advanced Knosp and Hardy stage, and elevated prolactin level at diagnosis. A prolactin level of <19 ng/mL in the first postoperative week predicted surgical remission with a sensitivity of 77.8% and a specificity of 70.6% in patients who received preoperative dopamine agonist treatment.
In macro adenomas and/or giant adenomas with cavernous sinus invasion, and significant suprasellar extension, which constitutes the difficult part of prolactinoma treatment, neither surgery nor medical treatment alone may be effective enough. Both treatment modalities should be carried out together by a team of neurosurgery and endocrinology in the management of these patients.
探讨内镜经鼻蝶窦手术（ETSS）治疗泌乳素瘤患者的初始缓解率和长期缓解率、缓解相关因素、辅助治疗和结局。
回顾性分析 2015 年至 2022 年间接受 ETSS 的 45 例泌乳素瘤患者的病历资料，获取相关人口统计学和临床数据。
21 例（46.7%）患者为女性。ETSS 时患者的中位年龄为 35（22.5-50）岁。患者的中位临床随访时间为 28（12-44）个月。初始手术缓解率为 60%。7 例（25.9%）患者复发。25 例患者术后使用多巴胺激动剂，2 例患者接受放射外科治疗，4 例患者接受二次 ETSS。在这些辅助治疗后，长期生化缓解率为 91.1%。与手术缓解失败相关的因素为：男性、年龄较大、肿瘤较大、Knosp 和 Hardy 分期较晚、诊断时催乳素水平升高。术前接受多巴胺激动剂治疗的患者中，术后第 1 周催乳素水平<19ng/mL 可预测手术缓解，其敏感性为 77.8%，特异性为 70.6%。
在大型腺瘤和/或海绵窦侵袭性巨大腺瘤以及明显的鞍上扩展中，手术和药物治疗都可能不足以达到理想效果。对于这些患者的治疗，应由神经外科和内分泌科团队共同采用两种治疗方式。
