title: Significance of surgical management for cystic prolactinoma.
abstract: OBJECTIVE
  It is generally accepted that dopamine agonists (DA) represent the first-line treatment for most patients with prolactinoma, and patients become candidates for surgical intervention when DA is contraindicated. Surgical indication for cystic prolactinoma remains controversial. This study was performed to investigate the significance of surgery for cystic prolactinoma.
  
  
  METHODS
  A total of 28 patients that underwent transsphenoidal resection of prolactinoma between February 2004 and May 2016 were reviewed. Five consecutive patients with cystic prolactinoma were included in this study. Our surgical strategy for cystic prolactinoma was categorized as follows: first, when the purpose of surgical resection was normalization of the prolactin level, aggressive resection was performed; second, when volume reduction was essential to relieve the visual symptoms and headache, internal decompression was performed followed by DA therapy. The clinical outcomes were analyzed accordingly.
  
  
  RESULTS
  All cystic prolactinoma were resected via the transsphenoidal approach without any complications, and all symptoms including visual impairment and hypogonadal activity were finally relieved combined with medication.
  
  
  CONCLUSIONS
  Surgery for cystic prolactinoma could be a better option. Transsphenoidal surgery is relatively safe to remove the cystic prolactinoma, additionally it can normalize the prolactine level and achieve adequate and rapid decompression of optic chiasm. The risk of transsphenoidal surgery is highly dependent on the skill of the surgeon and treatment decision for cystic prolactinoma needs to be individualized for each patient.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ogiwara
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. tetuyosi@shinshu-u.ac.jp.
authors.forename: Tetsuyoshi
authors.initials: T
authors.lastname: Horiuchi
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.|Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr City, Cairo, Egypt.
authors.forename: Alhusain
authors.initials: A
authors.lastname: Nagm
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D000328:Adult; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery; D015175:Prolactinoma / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D018491:Dopamine Agonists
keywords: Cystic adenoma; Dopamine agonists; Prolactinoma; Transsphenoidal surgery; Treatment