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¹İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Nöroşirürji Anabilim Dalı, İstanbul, Türkiye
²Prof. Dr. Mazhar Osman Bakırköy Ruh Sağlığı Hastalıkları EAH Nöroşirürji Kliniği, İstanbul, Türkiye Pituitary adenomas make up approximately 15% of all primary intracranial tumors. Lactotroph adenomas (prolactinomas) constitute 40% of all pituitary adenomas and are the most common group of active endocrine pituitary adenomas. The similar success of medical and surgical treatment for prolactinomas often creates a dilemma and differentiates this group from other pituitary adenomas. The prolactinoma may be asymptomatic or cause hypogonadism, infertility, galactorrhea, and irreversible decrease in spinal bone density secondary to the bone loss caused by a decrease in gonadal steroids. The treatment of symptomatic prolactinomas with dopamine agonists usually decreases prolactin levels, shrinks the tumor and enables gonadal functions to recover. Cabergoline treatment is therefore recommended for symptomatic prolactinomas. Surgery should be used for ‘drug-resistant prolactinoma’ cases where the prolactin level does not regress or the tumor shrinks less than 50% despite dopamine agonist treatment for the appropriate duration and with the appropriate dose (maximum tolerable dose). Cases that o not become fertile with standard dopamine treatment should also be accepted as ‘drug-resistant prolactinoma’ and surgical treatment considered. Clinicians should recommend transsphenoidal surgery for ‘dopamine agonist-resistant prolactinoma’ cases and for patients who cannot tolerate high-dose cabergoline treatment. The endoscopic endonasal transsphenoidal surgery (EETS) approach is becoming a popular transsphenoidal approach as it provides a better surgical field than microsurgery, and has good remission rates and lower complication rates. The surgical approach to prolactinoma is being reshaped with the widespread use of EETS and increasing experience. The use of conventional transcranial surgery for large, invasive and giant prolactinomas over 4 cm is now being debated as the effectiveness of EETS has been demonstrated. Radiotherapy can be used for residual and/or recurrent adenomas where surgery cannot be considered following medical treatment and surgical treatment. The most popular radiotherapy option is stereotactic surgery at present. Temozolomide should be tried independently of methylguanine-DNA-methyltransferase expression in aggressive and malignant prolactinomas where medical and surgical treatment is not effective. Anahtar Kelimeler : Surgical treatment, Prolactinoma