Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Role of Surgery for Patients With Functioning Pituitary Adenomas

Class III evidence suggests a benefit to surgery over medical management for growth hormone-secreting adenomas without evidence to support a benefit to pretreatment with a somatostatin analog before surgery. Class III evidence suggests a benefit to medical management over surgery in the treatment of patients with prolactinomas at primary diagnosis. There are insufficient data to support the benefit of endoscopic surgery compared with microscopic surgery, with or without additional adjuvant surgical techniques, for extent of surgical resection, hormone remission, length of stay, or complication rate, in the treatment of functional PA. There is a suggestion, however, that the endoscopic technique may be superior to the microscopic technique, for a shorter operative time and for extent of surgical resection and hormone remission rates for noninvasive pituitary macroadenomas. Similarly, there are insufficient data to support the use of reoperation for recurrent tumor compared with radiation and/or medical treatment.