Examining the viability of modern endoscopic endonasal surgery as a first-line treatment for macroprolactinomas: a multicentric study on the results and significance of the highest preoperative prolactin level in predicting long-term surgical outcomes

The authors found that modern EES in multidisciplinary centers was a low-morbid option for patients with macroprolactinoma. Remission rates were consistent with those of recent studies with variably sized prolactinomas, and recurrence rates were low. Although not universally definitive for macroprolactinomas, early EES can be offered for patients with the highest preoperative prolactin levels below 150 µg/L who are unwilling to receive long-term medication. Radiological criteria alone should not be the sole factor in surgical decision-making.