ORIGINAL ARTICLES   

Journal of Neurosurgical Sciences 2000 September;44(3):128-32

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

The neurosurgical management of prolactinomas

Ziya Gokalp H., Deda H., Attar A., Caglar Ugur H., Arasil E., Egemen N.

Department of Neurosurgery, Faculty of Medicine, University of Ankara, Ankara, Turkey

Background. The objec­tive was to dis­cuss the neu­ro­sur­gi­cal man­age­ment of the pro­lac­tin­o­mas.
Methods. Five-hundred-fifty ­patients suf­fer­ing ­from pro­lac­tin­o­ma ­were treat­ed ­with trans-­sphe­noid­al and trans­cra­ni­al ­approach. The diag­no­sis of pro­lac­tin­o­ma was ­based on var­i­ous ­degree of ­high lev­el pro­lac­ti­ne­mia, galac­tor­rhea, gono­dal dis­tur­bance, neu­ro­log­i­cal exam­ina­tion and radio­log­i­cal find­ings. In all cas­es the aden­o­ma was his­to­log­i­cal­ly ver­i­fied. The ­patients ­were inves­ti­gat­ed accord­ing to the ana­to­mo-radio­log­i­cal clas­sifi­ca­tion of Hardy and Vesina, and the ­range of pre­op­er­a­tive PRL ­basal lev­els.
Results. Follow-up was ascer­tained in 81% of ­patients who ­were fol­lowed for a ­mean of 7.2 ­year (1-10 ­year). While the ­total remov­al per­cent­age was 98% in the ­group ­with micro­pro­lac­tin­o­ma, ­this ­ratio ­dropped to 63.9% for mac­ro­aden­o­mas and 23.5% for ­giant aden­o­mas. Early improve­ment of pro­lac­tin lev­el ­ratio was 81.6% in micro­pro­lac­tin­o­mas, 28.3 in mac­ro­aden­o­mas and 11.7% in ­giant aden­o­mas. Hormonal ­cure was 64.3% in micro­aden­o­mas, 6.7% in mac­ro­aden­o­mas and 0% in ­giant aden­o­mas. The ­ratio of hor­mo­nal ­cure was decreas­ing in ­patients ­with ­high pro­lac­tin lev­els. In the fol­low-up recur­rence of pro­lac­tin­o­mas ­occurred in 39% of the ­patients.
Conclusions. Medical treat­ment is the ­first ­step in pro­lac­tin secret­ing aden­o­mas. Trans-sphe­noid­al micro­sur­gery ­became pop­u­lar in treat­ment of pro­lac­tin­o­mas ­because of low oper­a­tive mor­bid­ity and mor­tal­ity. Patients ­with recur­rence ­should be eval­u­at­ed for sec­ond ­step treat­ment (sur­gery, brom­o­crip­tine, or radio­ther­a­py).