Dear Sir,
Thank you for your query at DoctorSpring.com
Prolactinomas are tumours of the pituitary gland. They can be treated with cabergoline or bromocriptine. his is the medical management. The dose of the medication will be titrated based on the response of the patient as assessed by the prolactin levels.
If the prolactinoma is big enough to cause compression on the optic chiasma(as in your case) resulting in visual defects(details not available), we don't wait till the tumour shrinks with medicines. We will have to operate and debulk the tumour. However the maximum results which can be achieved is gross total excision(GTE) or many a times it is sub total excision(STE). In both the cases, there is chances of recurrence of the tumour after many years which cannot be accurately predicted. So cabergoline will have to be given in appropritate doses as required.
Answering your questions
1. It does make sense. This is the right decision
2. Surgery is the first option, followed by cabergoline
3. Any surgery has its set of complication, whether it is GTE or STE. I am sure the surgeon will mention it to you before surgery. There are many approaches to this tumour. Sublabial approach is one of the standard approaches.
Dr Goutham Cugati
Consultant Neurosurgeon
Patient replied :
Dr. Goutham Cugati,
Your reply was almost 100% satisfactory, thank you. But I am a little worried and I have to insist about the surgery risks. I know that every surgery has possible complications, but I just want to know if the risks for this kind of surgery are high. If I did understand correctly, in that case the surgery would be a sub total excision. I have two more questions:
- Is sub total excision surgery time shorter than gross total excision ?
- Does sub total excision has less risks than gross total excision ?
Dear Sir,
The risks involve
Common - not so serious:
Bleeding from operative site
Infection
Pain
Serious - not so common:
CSF leak from nose
Intracranial bleed
Injury to the optic nerves
Hormonal imbalance
I think you can have this list for guiding you for a pre-surgery discussion with your neurosurgeon.
Regards,
Dr Goutham Cugati
Patient replied :
Can't you really answer the other two questions ?
- Is sub total excision surgery time shorter than gross total excision ?
- Does sub total excision has less risks than gross total excision ?
Dear Sir,
The decision of subtotal or gross total excision is an on-table decision. The ideal term would be Maximum safe resection. Time is not at all a criterion in brain surgeries. Safety if of topmost concern
Regards,
Dr Goutham Cugati
Patient replied :
Dr. Goutham Cugati,
I'm sorry, but I'm not talking about the decision to do a sub total excision or a gross total excision. I just want to know if the surgery time of a subtotal excision is shorter than the surgery time of a gross total excision. Plus, I want to know if there are less risks involved when doing a sub total excision. And just to clarify: I was told that pituitary surgeries are not brain surgeries. Why did you say "brain surgery" ?
Dear sir,
The duration for subtotal and gross total excision will be same.
Pituitary gland is part of brain. And tumour of pituitary gland are considered tumours of the skull base. And I don't understand why should someone say that surgery of pituitary tumour is not a brain surgery.
Regards.