Endoscopic surgery for noninvasive prolactinomas: A large multicenter, single-arm, retrospective study (PRLomaSaR).

PURPOSE: To determine the efficacy of endoscopic transsphenoidal surgery (TSS) in patients with noninvasive prolactinomas of Knosp grades 0–2. METHODS: A retrospective analysis was performed in 90 patients from five centers who had noninvasive prolactinomas and underwent endoscopic TSS from January 2020 to April 2023. The hormone remission (HR) rates of prolactin (PRL) and potential variables affecting surgical outcomes were analyzed. RESULTS: Among these 90 patients with prolactinomas, 1 patient was excluded because of loss to follow-up at 9 months. Among the 89 patients, 34 and 55 were males and females, respectively. There were 26 microadenomas and 63 macroadenomas. In terms of Knosp grade, 35, 36, and 18 cases were grade 0, 1, and 2, respectively. The total HR rate at 1 year after surgery was 89.89% (80/89). Specifically, the HR rates of patients with microadenomas and macroadenomas were 96.15% and 87.30%, respectively. The HR rates for patients with Knosp grades 0, 1, and 2 tumors were 94.24%, 83.33%, and 94.44%, respectively. Different variables, including age, sex, tumor size, Knosp grade, preoperative PRL levels, and medical history, were not different between the surgery-induced HR and non-HR groups. Postoperative complications included 3.37% CSF leakage, 1.12% permanent hypopituitarism, and 4.49% diabetes insipidus. CONCLUSION: Endoscopic TSS can be performed as an effective treatment strategy for noninvasive prolactinomas at the Pituitary Adenoma Center of Excellence.