Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

Abstract

Pituitary tumors are relatively common, with reported prevalence rates ranging from 10% to 22% and accounting for 10% to 15% of all intracranial tumors. 3,5,22 With the advent of neuroimaging, the incidental finding of pituitary adenoma has become much more frequent. Chronic headache is a common reason for undergoing neuroimaging. The incidence of headache in patients with pituitary adenomas has been reported to range between 33% and 72%. 1,6,23 The existence of any clear relationship between headaches, pituitary tumors, and surgical treatment of pituitary tumors remains to be elucidated. Chronic headache in patients with pituitary tumors may arise from several putative mechanisms, including tumor volume and its relationship with the sellar structures, functional disturbance within the hypothalamopituitary axis, patient predisposition, and family history. 8,9 Invasion of the cavernous sinus is a proposed etiology of headache given that the sinus contains the ophthalmic branch of obJective The relationship between headaches, pituitary adenomas, and surgical treatment of pituitary adenomas remains unclear. The authors assessed the severity and predictors of self-reported headaches in patients referred for surgery of pituitary adenomas and evaluated the impact of endoscopic transsphenoidal surgery on headache severity and quality of life (QOL). methods In this prospective study, 79 patients with pituitary adenomas underwent endoscopic transsphenoidal resection and completed the Headache Impact Test (HIT-6) and the 36-Item Short Form Health Survey (SF-36) QOL questionnaire preoperatively and at 6 weeks and 6 months postoperatively. results Preoperatively, 49.4% of patients had mild headache severity, 13.9% had moderate severity, 13.9% had substantial severity, and 22.8% had intense severity. Younger age and hormone-producing tumors predisposed greater headache severity, while tumor volume, suprasellar extension, chiasmal compression, and cavernous sinus invasion of the pituitary tumors did not. Preoperative headache severity was found to be significantly associated with reduced scores across all SF-36 QOL dimensions and most significantly associated with mental health. By 6 months postoperatively, headache severity was reduced in a significant proportion of patients. Of the 40 patients with headaches causing an impact on daily living (moderate, substantial, or intense headache), 70% had improvement of at least 1 category on HIT-6 by 6 months postoperatively, while headache worsened in 7.6% of patients. The best predictors of headache response to surgery included younger age, poor preoperative SF-36 mental health score, and hormone-producing microadenoma. coNclusioNs The results of this study confirm that surgery can significantly improve headaches in patients with pituitary adenomas by 6 months postoperatively, particularly in younger patients whose preoperative QOL is impacted. A larger multicenter study is underway to evaluate the long-term effect of surgery on headaches in this patient group.

Analysis and natural history of pituitary incidentalomas

“…This correlates well with our finding that it accounted for 28% of the indications for initial imaging. Furthermore, resolution of headache in some patients after surgery has been reported but it is unclear if it is due to the removal of the tumor, effect of anesthesia or the natural history of headaches (20,21). This raises an important question: if there were a clear causal association between headache and PI, would it be correct to label these lesions as incidental?…”

Pre- and Postoperative Health Status of Patients with Nonfunctioning and Secretory Pituitary Adenomas and an Analysis of Related Factors

“…PF, MH, and RP were all more seriously impaired in patients with ACTH-secreting adenomas than in patients with GH-secreting adenomas. International Journal of Endocrinology Studies on the risk factors for impaired health status have indicated that headache is related to a reduced SF-36 score, especially the mental component [9,26]. Levels of 24 h UFC were negatively correlated with mental health status scores but not physical health status scores in patients with ACTH-secreting adenomas [8].…”

“…Several previous studies focused on the quality of life of patients with pituitary adenomas [5][6][7][8][9]. Patients with active disease and severe headache, as well as younger patients, had an elevated risk of diminished quality of life [8,9]. High levels of prolactin (PRL) and 24 h urine free cortisol (24 h UFC) were associated with reduced quality of life in patients with prolactinomas and adrenocorticotropic hormone-(ACTH-) secreting adenomas [8].…”

“…High levels of prolactin (PRL) and 24 h urine free cortisol (24 h UFC) were associated with reduced quality of life in patients with prolactinomas and adrenocorticotropic hormone-(ACTH-) secreting adenomas [8]. After treatment, with the elimination of tumor mass effects and the mitigation of elevated hormone levels, the reduced quality of life in patients with pituitary adenomas was reported to be reversed in some literature [9][10][11]. However, systemic evaluation was not well achieved.…”

“…We were interested in whether these psychological factors had negative effects on patients' health status. In the literature, 6 weeks, 6 months, and 1 year after treatment are used as time points used to evaluate the reversibility of reduced health status [9][10][11], but the effects at 3 months after treatment, which is also an important time point for surgeons, have not been well evaluated.…”