I noted these about 6 years ago either from a medical book or from an older abstract. Source now mislaid but is considered accurate. Percentages are from source, additional viewpoints and comments are my own and represent my own understanding only (review them with your doctor).
Surgery has its risks. Mortality rate 0.86%, morbidity rate 6.3%. Major complications cerebrospinal rhinorrhea 3.3% (cerebrospinal fluid from the brain drips down the nose), permanent visual loss 1.5%, permanent oculomotor palsy (0.6%) and meningitis (0.5%). Hypopituitararism (pituitary stops working) occurs in an additional 10% of patients. (Don't forget the pituitary is THE master gland which controls most other glands in the body, it is the interface between the brain and the endocrine system and it is a big problem if it stops working - lifetime medication and impossible to have children, whereas the original high prolactin lack of ovulation may have been fixable). Transient diabetes insipidus occurs in about 5% and is permanent in 1% (this is where you cannot stop urinating and must drink large quantitites of water, may be controllable by lifelong medication)
Surgery has a high failure rate in macroprolactinomas (size 1 centimeter and greater) because most of them grow back, and does not guarantee success in microprolactinomas (size under 1 centimeter). In my opinion, unless the tumour size cannot be reduced by medication and it is growing or causing size problems, it is a personal decision as to whether surgery is worth the risk. Women who want to have children should be particularly cautious because of the 10% risk of Hypopituitararism. (I am not sure what affect this has on male reproduction.) If you do have surgery try to find a neurosurgeon who has done a lot of these operations, 200 is probably minimum to shoot for, 500 is better, and of course a good success rate.
You might want to look at this article Complications of Transsphenoidal Surgery: Results of a National Survey, Review of the Literature, and Personal Experience for a more detailed review of the risks
Return to my Treatment of Prolactinomas page
This Page Last Updated on 6th. July, 2000