Contribution of Intrasellar Pressure Elevation to Headache Manifestation in Pituitary Adenoma Evaluated With Intraoperative Pressure Measurement

Hayashi, Yasuhiko; Sasagawa, Yasuo; Oishi, Masahiro; Kita, Daisuke; Misaki, Koichi; Fukui, Issei; Tachibana, Osamu; Nakada, Mitsutoshi

doi:10.1093/neuros/nyy087

Cited by 17 publications

(12 citation statements)

References 24 publications

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“…We found that a risk factor for migraine was younger age, as already shown by others (Hayashi et al., 2019; Schankin et al., 2012). However, such an association was not observed in patients with non‐functioning PAs (Yu et al., 2017).…”

Section: Discussionsupporting

confidence: 89%

“…The overall prevalence of migraine in our cohort was 30%, thus 1.6 times higher than in the general French population (Lantéri‐Minet, Valade, et al., 2005). Indeed, the reported prevalence of migraine varies from 11% to 42% (Hayashi et al., 2019; Siegel et al., 2017; Yu et al., 2017; Zhang et al., 2019). However, it is noteworthy that the highest migraine prevalence was found in the study that enrolled only patients with non‐functioning PA (Yu et al., 2017).…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of pain in patients with pituitary adenomas: A cross‐sectional study

Dallel

Devoize

Tauveron

et al. 2021

European Journal of Pain

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Background This study determines the prevalence and particularities of headache and pain with neuropathic characteristics (NC) in a large French group of patients with pituitary adenoma (PA). Methods Analysis of validated self‐administered questionnaires, radiological characteristics and treatment strategies of PA was performed. Results Of the 221 sent questionnaires, 146 could be used for statistical analysis, 50% of which were completed by women. Among responders, 58.9% had pain: 30.1% migraine, 15.7% pain with NC and 13.1% other types of pain. Migraine was more common in patients with PA than in the general population (30.1% vs. 21.3%, p = .010) and attacks received appropriate treatment for less than 20% of these patients. Furthermore, the prevalence of chronic migraine was much higher than in the general population (6.8% vs. 2.2%, p = .003). Neuropathic pain was also more frequent in PA patients than in the general population (15.8% vs. 6.9%, p < .001). Neuropathic pain was most often located in the extremities and was frequently described as an ‘electric shock’, ‘numbness’, or ‘pins‐and‐needles’. Multivariate analyses linked migraine to younger age, anxiety, pain with NC, and a visible tumour on MRI, regardless of its invasiveness or secretory nature. Conclusions Migraine headaches and neuropathic pain are more frequent and disabling in PA patients than in the general population. Both types of pain are comorbid in PA patients and are poorly treated. Migraine is associated with the presence of a tumour. Thus, biological mechanisms of this relationship need to be characterized to design optimal treatments for these individuals. Significance Migraine headaches and neuropathic pain are more common in PA patients than in the general population and are generally poorly treated. A systematic screening for migraine should be done by physicians in daily practice to provide adequate therapeutics.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Characteristics of pain in patients with pituitary adenomas: A cross‐sectional study

Dallel

Devoize

Tauveron

et al. 2021

European Journal of Pain

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“…[6,8,12,21] e cause of headaches is unknown but is thought to be related to stretch of the diaphragma dura. [9] Our patient's headaches were chronic and bifrontal in nature. e visual dysfunction associated with SAC typically presents as bitemporal hemianopia due to compression of the optic chiasm.…”

Section: Discussionmentioning

confidence: 63%

Orbitofrontal approach for the fenestration of a symptomatic sellar arachnoid cyst

Aljuboori

Burke

Yeo

et al. 2020

Surgical Neurology International

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Background: Sellar arachnoid cysts (SACs) are rare lesions and incidentally found on brain imaging. The pathophysiology is poorly understood. Some authors suggested that SACs develop as a herniation of arachnoid membrane through the diaphragma sellae followed by cyst formation. Furthermore, Meyer et al. postulated that SACs are formed by splitting of the arachnoid layers. Symptomatic SACs present with headache, visual field deficit, or pituitary dysfunction. The data are limited on the indications and timing for intervention. We present a case of symptomatic SAC that was fenestrated using orbitofrontal approach. Case Description: A 64-year-old female presented with chronic headaches and blurriness of vision. She was previously diagnosed with diabetes insipidus (DI) that was treated with desmopressin, magnetic resonance imaging (MRI) of her brain at that time was normal. Later on, she developed severe headaches that were managed medically. A year later, she had an episode of generalized seizure that led to the discovery of SAC on brain MRI. On examination, she had a left-sided monocular temporal hemianopia. The patient underwent an orbitofrontal craniotomy for fenestration of the SAC. At 6-month follow-up, her headaches had significantly improved with the resolution of the visual deficit. In addition, the DI had resolved, and the desmopressin was discontinued. Conclusion: SACs are rare with no consensus on the indications for surgery. Our experience suggests that fenestration of SAC through transcranial approach is a valid option for patients with visual deficit and/or pituitary dysfunction.

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“…Elevated intrasellar pressure (ISP) is known to occur in patients who have pituitary lesions, and it has been suggested as a cause for the clinical symptoms as the symptoms resolve after surgical reduction of ISP [ 9 , 10 ]. Elevated pressure on the pituitary gland, either indirectly from increased intracranial pressure, or directly from cerebrospinal fluid leaking into the pituitary fossa, is a known cause for the empty sella syndrome (ESS).…”

Section: Discussionmentioning

confidence: 99%

“…It is not necessarily absent in patients with normoprolactinemia [ 7 ]. Based on such observations, surgery may be a better treatment option than pharmaceutical agents because surgical removal of a lesion will eliminate the stalk effect [ 8 ] and/or elevated ISP [ 9 , 10 ]. Surgical removal of NFPA and drainage of cysts have been demonstrated to provide durable normalization of serum PRL levels and to achieve significant symptom reduction or resolution [ 7 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Full Remission of Long-Term Premenstrual Dysphoric Disorder-Like Symptoms Following Resection of a Pituitary Adenoma: Case Report

Shiver

Blackburn

et al. 2020

Am J Case Rep

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Contribution of Intrasellar Pressure Elevation to Headache Manifestation in Pituitary Adenoma Evaluated With Intraoperative Pressure Measurement

Abstract: Headache in patients with pituitary adenomas associated with ISP elevation, results from compromised dural integrity at the sella and intratumoral hemorrhage. The increased stretch force of the sella dura may be a notable etiology of headache in patients with pituitary adenoma.

Cited by 17 publications

References 24 publications

Characteristics of pain in patients with pituitary adenomas: A cross‐sectional study

Characteristics of pain in patients with pituitary adenomas: A cross‐sectional study

Orbitofrontal approach for the fenestration of a symptomatic sellar arachnoid cyst

Full Remission of Long-Term Premenstrual Dysphoric Disorder-Like Symptoms Following Resection of a Pituitary Adenoma: Case Report

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