Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, "mainly endoscopic/mainly microscopic practice" and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1-5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.

Department of Internal Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague Czech Republic

Department of Methodology Faculty of Physical Education and Sport Charles University Prague Czech Republic

Department of Neuroscience Rita Levi Montalcini Neurosurgery Unit University of Turin Turin Italy

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital U Vojenske Nemocnice 1200 169 02 Prague 6 Czech Republic

Department of Neurosurgery Johannes Gutenberg Universität Mainz Mainz Germany

Department of Neurosurgery Kings College London UK

Department of Neurosurgery Lariboisière University Hospital Paris France

Department of Neurosurgery Radboud University Medical Centre Nijmegen Nijmegen The Netherlands

Institute of Biophysics and Informatics 1st Faculty of Medicine Charles University Prague Czech Republic

Neurosurgery Department University Hospital Donostia San Sebastian Spain

St Department of Neurosurgery Aristotle University of Thessaloniki Thessaloniki Greece

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