gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Operative treatment of prolactinomas – Current indications and results in 185 patients

Operative Therapie von Prolaktinomen – Aktuelle Indikationen und Resultate in 185 Patienten

Meeting Abstract

  • corresponding author J. Kreutzer - Neurochirurgische Klinik, Universität Erlangen
  • H. Wallaschofski - Medizinische Klinik, Abtl. für Endokrinologie und Stoffwechsel, Universität Erlangen
  • R. Buslei - Institut für Neuropathologie, Universität Erlangen, Universität Erlangen
  • B. Hofmann - Neurochirurgische Klinik, Universität Erlangen
  • C. Nimsky - Neurochirurgische Klinik, Universität Erlangen
  • R. Fahlbusch - Neurochirurgische Klinik, Universität Erlangen
  • M. Buchfelder - Neurochirurgische Klinik, Universität Erlangen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.01.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc162.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Kreutzer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Medical therapy with Dopamine-agonists (DA) is the primary treatment of choice in most patients with prolactinomas. “Classical” indications for operative therapy have been persisting hyperprolactinemia and/or insufficient shrinkage of the tumors. Focusing on a possible shift of operative indications with new DA having become more effective with less side effects during the last 15 years, we retrospectively analyzed our operative results in a series of 185 patients with prolactinomas.

Methods: Between 1990 and August 2005 we operated on 218 consecutive patients with prolactinomas, who had reliable and completed data meeting the study protocol in 185 patients. Mean follow-up time was 15.8 months. Remission rates were defined by serum PRL-levels less than 500 µU/ml. Operative indications were divided into “classical” groups such as DA side-effects, persistent hyperprolactinemia, insufficient shrinkage of tumor and “modern” groups such as cystic tumors and patients wish for an primary operative therapy.

Results: Pure surgical remission was 80.3% (is, intrasellar), 61.4% (s1, suprasellar without visual deficits), 14.7% (s2, suprasellar with visual symptoms), 25% (ps/sph, parasellar/sphenoidal) and 0% in giant tumors resulting in an overall surgical remission rate of 49.7%. Follow-up remission in combination with postoperative adjunctive DA-therapy was 72.5% (is), 67.3% (s1), 37.5% (s2), 61.5% (ps/sph) and 40% (giant) resulting in an overall combined remission rate of 60.8%. During the time periods 1990-1995, 1995-2000 and 2000-2005 we operated on patients with DA side-effects in 25%, 15.7% and 12.7% of cases as well as in patients with persistent hyperprolactinemia in 18.3%, 10% and 7.3% of cases. Thus both “classical” groups are becoming continuously less. In contrast, the number of patients with cystic tumors asking for primary operative therapy has increased (16.6%, 32.9% and 25.5%, respectively).

Conclusions: Overall remission rates after surgical treatment of prolactinomas remain excellent with an emphasis on intrasellar macro- and microadenomas. The combination of the well known low morbidity of transsphenoidal surgery with the introduction of modern, more effective and better tolerated DA has led to a change. From our point of view this has also resulted in an expansion of the indications for operative therapy including more young patients with cystic tumors, who personally wish for a primary, possible definitive surgical treatment.