Abstract】Objective: To analyze the efficacy of transsphenoidal surgery for non-invasive pituitary prolactin adenoma and to provide reference for clinical treatment selection. Methods: To retrospectively analyze the surgical efficacy of 234 patients treated by transsphenoidal surgery in our department in the past 10 years and to analyze the factors affecting the surgical efficacy. Results: There were no surgical deaths. There were 127 cases (54.3%) of transient water and electrolyte disorders after surgery. There were 188 cases of cure (80.3%), 12 cases of remission (5.1%), 20 cases of improvement (8.5%), and 14 cases of failure (6.0%). Patient gender, tumor size and preoperative PRL level had a highly significant effect on the outcome after transsphenoidal surgery, whereas the preoperative course of disease, preoperative bromocriptine withdrawal or not, tumor texture, whether the tumor was stroked or not, and the degree of intraoperative saddle diaphragm descent had no significant effect on the outcome of transsphenoidal surgery for non-invasive pituitary prolactin adenoma. The total cost of transsphenoidal surgery was $(12912.0±2361.2). CONCLUSION: Transsphenoidal microsurgical treatment can be used as a primary treatment for non-invasive pituitary prolactin adenomas, especially microadenomas and macroadenomas. Pituitary PRL adenoma is the most common pituitary adenoma, and there is still a debate both domestically and internationally as to whether surgery or drug therapy is preferred for its primary treatment. In foreign literature, dopamine agonist drugs are preferred for the primary treatment of pituitary PRL adenoma, mainly bromocriptine, pergolide, hyperlipid, and cartegolide. Dopamine agonists can normalize blood PRL in 70-80% of patients with pituitary PRL adenomas, reduce tumor size in about 80% of patients with PRL macroadenomas, and achieve remission in 75.6% to 92% of patients with PRL microadenomas. However, these drugs do not cure PRL adenomas, and patients may require long-term or even lifelong medication. In addition, 4.5% to 10% of patients with prolactinomas have difficulty tolerating the side effects of the drugs or the medication is ineffective. In recent years, surgical treatment of pituitary PRL adenomas has gained renewed interest, giving rise to a debate on the primary treatment of pituitary prolactinomas. In experienced neurosurgeons, the long-term cure and remission rate of pituitary prolactinoma after pteroplasty can be as high as 70-80%, and the long-term cure and remission rate of pituitary prolactin microadenoma and prolactinoma confined to the saddle can be as high as 80-90%, and women with infertility due to pituitary prolactinoma can have 90% chance of pregnancy and childbirth after surgery as long as the blood PRL is normalized, which is really the purpose of eradication. The treatment is truly radical. The cured remission rate of 85.5% in our group of non-invasive pituitary PRL adenomas treated with butterfly surgery is comparable to that reported in the literature with dopamine agonists, but the effect of surgical treatment may be long-term and radical, and the cost of surgical treatment is even lower than that of drug treatment. Cured cases avoid the expensive medical costs associated with lifelong medication, the inconvenience associated with daily/weekly medication, and the low self-esteem associated with medication and survival with tumors in some patients, allowing them to move normally into society. Our data showed that patient’s gender, preoperative PRL value and tumor size have certain postoperative prognostic value, i.e., female cases have better outcome than male cases with transsphenoidal surgery, those with low preoperative PRL have better outcome than those with high PRL, and those with microadenomas and macroadenomas have better postoperative outcome than those with giant adenomas, similar to what has been reported in the literature. In contrast, the preoperative course of disease, preoperative bromocriptan, tumor texture, whether the tumor was stroked, and the degree of intraoperative saddle diaphragm descent did not have a significant effect on the efficacy of transsphenoidal surgery for non-invasive pituitary PRL adenomas. In China, it has been reported in the literature that the average follow-up after primary treatment, i.e., treatment of pituitary prolactin adenoma with gamma knife, was 37 months, and the tumor growth control rate was 100%, but the endocrine remission rate was only 40.0% , while the incidence of pituitary hypopituitary function was as high as 17.6%. Therefore, gamma knife cannot be easily used as a primary treatment for pituitary prolactin adenoma, and radiation therapy, including gamma knife, should be considered only when both surgical and pharmacological treatments are ineffective. Therefore, trans-sphenoidal surgical treatment can be used as a primary treatment for non-invasive pituitary prolactinomas, both in terms of treatment efficacy, patient convenience, rebuilding confidence for the patient, and treatment cost. Patient gender, preoperative PRL values, and tumor size can be used as references to assess the efficacy of surgery. In the current medical environment, it is relatively reasonable to detail the pros and cons of pharmacological and surgical treatment to patients and then let them make their own choice.