The Changing Treatment Paradigm for Prolactinoma-A Prospective Series of 100 Consecutive Neurosurgical Cases

Purpose: To evaluate patients with prolactinoma treated surgically in a time when elective prolactinoma surgery became routine in our center, using a comprehensive outcome set, focusing on preoperative assessments, surgical outcomes, and health-related quality of life (HR-QoL). Methods: Cohort of consecutive patients with prolactinoma undergoing surgery between January 2021 and August 2023. Clinical data were collected during multidisciplinary team meetings/from medical records at distinct timepoints: (1) presurgery, (2) 2 weeks postsurgery, (3) 6 months postsurgery, and (4) follow-up (median, 15.0 [10.0-24.8 months]). HR-QoL was measured using the Leiden Bothers and Needs Pituitary questionnaire. Data were described for all patients, and patients undergoing elective total resection, with additional subgroups of (1) patients undergoing a high-probability first total resection and (2) reoperations aiming for total resection. Results: One hundred surgically treated patients with prolactinoma were included (72 female). Dopamine agonist intolerance was the most frequent indication (n = 68). The surgical goal (debulking/total resection) was achieved in 90% of patients. Long-term complications occurred in 4% of patients. Seventy-eight patients underwent an elective total resection, achieving remission in 91%. The subsets of preoperatively estimated high-probability-first total resections (n = 52) and reoperations (n = 9) achieved remission in 92% and 89%, respectively. Leiden Bothers and Needs Pituitary Total Bothers and Total Needs scores improved significantly after surgery (P < .001, Δ-3.4 [interquartile range, -14.4 to -0.9] and P = .006, Δ-1.8 [interquartile range, -11.9 to 1.3]), respectively. Conclusion: High remission rates were achieved, improving HR-QoL, demonstrating (repeat) prolactinoma surgery is effective in an experienced pituitary center, as highlighted in the most recent guideline (2023).