Medical therapy is the treatment of choice for prolactinomas, with surgery reserved for certain patients. Current surgical indications for prolactinomas were studied. Indications of surgery, clinical outcome, biochemical cure, and extent of resection were assessed in 30 patients. Main indications included failed medical treatment and marked diminution of vision. Biochemical cure was obtained in half of patients particularly those with smaller tumors. Surgery in indicated patients achieves visual improvement and good remission rates particularly in patients with micro-adenomas or intrasellar macroadenomas, with low rate of complications.