World neurosurgery · 2026
Surgical Outcomes in Knosp Grade 3 or 4 Macroprolactinomas: What Role Does Debulking Surgery Play?
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ovenden Christopher, Tan Victoria, Torpy David J, Chapman Ian, Saran Frank, Jukes Alistair, Santoreneos Stephen, Vrodos Nikitas, Poonnoose Santosh, Candy Nicholas, Psaltis Alkis, De Sousa Sunita M C
Аннотация
PURPOSE: To determine the clinical outcomes of patients who had surgery to treat Knosp 3 and 4 prolactinomas with a particular focus on hormonal outcomes.
METHODS: Retrospective cohort review of South Australian patients who had surgery to treat Knosp 3 and 4 prolactinomas from January 2000 to June 2025. Tumors were resected via an endoscopic, endonasal trans-sphenoidal approach. Demographic and clinical parameters were recorded. Hormonal outcomes were measured through assessment of prolactin levels and weekly cabergoline dose preoperatively and then at 3 months postoperatively.
RESULTS: Of 54 total operated prolactinomas, 11 were Knosp 3 or 4 prolactinomas. Mean age at surgery was 43 years (±16, range 26-77). Knosp grade was 3 in 3 cases and 4 in 8 cases. The most common surgical indications were dopamine agonist resistance (5 cases) or intolerance (3 cases). Six patients had visual deficits preoperatively, with improvement following surgery in 5 cases (83%). PRL level prior to surgery was a mean of 82 times the upper limit of normal (±16, range 0-576), with a decline to 28 (±50, range 0-16) at 3 months postoperatively. In 6 patients on cabergoline preoperatively, 3 were on a reduced dose at 3 months postoperatively, with 3 on a stable dose.
CONCLUSIONS: Surgery was effective at addressing visual compromise in cavernous sinus invasive prolactinomas but had a limited effect on prolactin control and the ability to reduce dopamine agonist use.
METHODS: Retrospective cohort review of South Australian patients who had surgery to treat Knosp 3 and 4 prolactinomas from January 2000 to June 2025. Tumors were resected via an endoscopic, endonasal trans-sphenoidal approach. Demographic and clinical parameters were recorded. Hormonal outcomes were measured through assessment of prolactin levels and weekly cabergoline dose preoperatively and then at 3 months postoperatively.
RESULTS: Of 54 total operated prolactinomas, 11 were Knosp 3 or 4 prolactinomas. Mean age at surgery was 43 years (±16, range 26-77). Knosp grade was 3 in 3 cases and 4 in 8 cases. The most common surgical indications were dopamine agonist resistance (5 cases) or intolerance (3 cases). Six patients had visual deficits preoperatively, with improvement following surgery in 5 cases (83%). PRL level prior to surgery was a mean of 82 times the upper limit of normal (±16, range 0-576), with a decline to 28 (±50, range 0-16) at 3 months postoperatively. In 6 patients on cabergoline preoperatively, 3 were on a reduced dose at 3 months postoperatively, with 3 on a stable dose.
CONCLUSIONS: Surgery was effective at addressing visual compromise in cavernous sinus invasive prolactinomas but had a limited effect on prolactin control and the ability to reduce dopamine agonist use.