Macroadenoma surgery when ??

Surgical Intervention Tumors that are unresponsive to bromocriptine or that cause persistent visual field loss require surgical intervention. Some neurosurgeons have noted that a short (2-to 6 weeks) preoperative course of bromocriptine increases the efficacy of surgery in patients with larger adenomas  Unfortunately, despite surgical resection, recurrence of hyperprolactinemia and tumor growth is common; complications of surgery include cerebral carotid artery injury, diabetes insipidus, meningitis, nasal septal perforation, partial or panhypopituitarism, spinal fluid rhinorrhea, and third nerve palsy. Periodic MRI scanning after surgery is indicated, particularly in patients with recurrent hyperprolactinemia.