Significant headache improvement after transsphenoidal surgery in patients with small sellar lesions

Fleseriu, Maria; Yedinak, Christine G.; Campbell, Caitlin; Delashaw, Johnny B.

doi:10.3171/2008.8.jns08805

Cited by 56 publications

(38 citation statements)

References 26 publications

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“…Neurosurgeons occasionally have difficulty in determining whether pituitary lesions demonstrated on MRI are responsible for the headache or whether pituitary lesions together with headaches should be considered a simple co-incidence [1,7]. Although the clinical characteristics of headaches in pituitary tumor cases are extremely variable, Fleseriu et al found that chronic daily headaches and self-reported migraines represented 75% of these cases, surpassing other types of headaches [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…Although the clinical characteristics of headaches in pituitary tumor cases are extremely variable, Fleseriu et al found that chronic daily headaches and self-reported migraines represented 75% of these cases, surpassing other types of headaches [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanism of headache in patients with pituitary adenoma remains unclear [1,2,3]. The widespread availability of advanced neuroradiological instruments has increased the chances of detecting patients with both pituitary adenoma and headaches.…”

Section: Introductionmentioning

confidence: 99%

“…The factors contributing to the induction of headache in patients with pituitary adenoma are likely as follows; 1) compression or stretch of vessels and dural structures at the base of the brain, 2) increased sellar pressure, and 3) hormonal hypersecretion [1,3,8]. Among these factors, we focused on compression or stretch of the diaphragm sellae and the medial wall of cavernous sinus, the presence of cyst or hematoma in the adenoma, and ossification in the sphenoid sinus.…”

Section: Introductionmentioning

confidence: 99%

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Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement

et al. 2015

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4Results. All nine patients had complete or substantial resolution of their formerly intractable headache after TSS. Headaches consisted of ocular pain ipsilateral to the adenoma localization within the sella in four cases and bifrontal headache in five.Magnetic resonance imaging of these patients revealed small diaphragmatic foramen, which were so narrow that only the pituitary stalk could pass. Computed tomography scans showed ossification beneath the sellar floor in the sphenoid sinus, presellar type in six cases, and choncal type in three. The adenomas included cysts in seven cases.There was no cavernous sinus invasion. Intrasellar pressure measurements averaged 41.5 ± 8.5 mmHg, range 34-59, significantly higher than in control patients without headache (n = 12), namely 22.2 ± 10.6 mmHg (16-30).Conclusion. In this study, the authors demonstrated the validity of TSS in the treatment of intractable headache associated with pituitary adenoma. The presence of ocular pain, especially ipsilateral to the adenoma, integrity of the diaphragm sella, and ossification in the sphenoid sinus, cyst or hemorrhage and the absence of cavernous sinus invasion were the indications for TSS for patients complaining of intractable headache and having pituitary adenomas. 5

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement

et al. 2015

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“…Among functional pituitary tumours, growth hormone (GH)-secreting adenomas and prolactinomas have been specifically associated with headache, possibly mediated by the change in endocrine status rather than the pituitary mass per se (2). Transsphenoidal surgery may lead to significant improvement in headache in patients with non-secreting and hypersecretory pituitary microadenomas (3).…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of pain in patients with pituitary adenomas

Dimopoulou

Athanasoulia

Hanisch

et al. 2014

European Journal of Endocrinology

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Objective: Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the clinical characteristics of pain in a large cohort of patients with pituitary disease. Design: In a cross-sectional study, we assessed 278 patients with pituitary disease (nZ81 acromegaly; nZ45 Cushing's disease; nZ92 prolactinoma; nZ60 non-functioning pituitary adenoma). Methods: Pain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL). Results: We recorded a high prevalence of bodily pain (nZ180, 65%) and headache (nZ178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (nZ34, 76%). Headache was equally frequent in patients with macroand microadenomas (68 vs 60%; PZ0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (nZ193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL.Conclusions: Pain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL.

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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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Significant headache improvement after transsphenoidal surgery in patients with small sellar lesions

Abstract: In this retrospective study, the authors demonstrate the efficacy of TSS in the treatment of intractable headaches in patients who present with pituitary microadenomas (nonsecreting and hypersecretory) and Rathke cleft cysts.

Cited by 56 publications

References 26 publications

Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement

Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement

Clinical characteristics of pain in patients with pituitary adenomas

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

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