Predictive Factors on Remission after Transsphenoidal Surgery for Prolactinomas

Hur, Sung Min; Koh, Eun Jeong; Choi, Ha Young

Abstract

OBJECTIVE
This study is designed to demonstrate the factors influencing on the the postoperative remission or recurrence after transsphenoidal approach(TSA) for treatment of the prolactinomas.
METHODS
This study included 18 patients who underwent TSA. Pre- and post-operative magnetic resonance(MR) image, and serum prolactin levels were checked. Classification(Grade I-V, Stage 0-E) of the tumor were performed based on the preoperative MR image and intraoperative surgical finidngs. "Remission" was defined when normal serum prolactin level without amenorrhea, galactorrhea was noticed. "Recurrence" was defined when postoperative prolactin level was above 20ng/ml and amennorrhea, galactorrhea were presented.
RESULTS
Patients were grade I in eight, grade II in six, grade III in three, and grade IV in one. Postoperative results showed remission in 13 and recurrence in five. Depending on preoperative serum prolactin levels, remission was achieved in 100% of patients under 100ng/ml, 83% of patients in 100-200ng/ml, and 50% of patients above 200ng/ml. Remission was noticed in 75.0% of grade I, 83.3% of grade II, 66.6% of grade III, and 0% of grade IV. Also, remission was presented in 80.0% of stage 0, 66.7% of stage A, 0% of Stage B.
CONCLUSION
After TSA, remission could be achieved in patients with low preoperative serum prolactin level, small sized tumor, and less invasive tumor into the sellar floor. It is suggested that preoperative serum prolactin level, tumor size, and invasiveness of the tumor into the sellar floor are of value in prediction of the remission after TSA in patients with prolactinoma.