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

Abstract

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

Changes in clinicopathological profile post Trans-sphenoidal surgery in patients with Pituitary Adenomas: An Institute based study from North East India

“…Similar fi ndings were reported from Oregon, USA and also from Japan. 12,13 In our study, 50% of the adenomas were nonfunctioning (NFPA). In those that caused clinically signifi cant and detectable hormone levels, prolactin producing adenomas were commonest, followed by GHproducing adenomas and ACTH-producing adenomas.…”

Contribution of sellar dura integrity to symptom manifestation in pituitary adenomas with intratumoral hemorrhage

“…I apologized I did not mention the explanation about consciousness disturbance in patients in group C. Consciousness disturbance occurred in 3 patients in our study, and all of them were included only in group C (Page 13, line [1][2][3]. We believe that their consciousness disturbance was caused by pituitary hormonal insufficiency (hypopituitarism), because their consciouness disturbance improved remarkably soon after administration of corticosteroid.…”

“…In addition, "no extrasellar extension" was observed in the patients in group C alone, and all of them presented with severe headache. In those cases, the integrity of the sellar dura was completely preserved, suggesting that the occurrence of hemorrhage within the adenomas caused a rapid elevation of the tension force on the sellar dura (3,21,23,26). In group C, all the patients who presented with visual function disturbance revealed unidirectional extension into the suprasellar region.…”

“…MRI was performed with both spin echo T1-and T2-weighted sequences. For T1-WI, the following were used: (3,17). Tumor characteristics (maximum diameter, proportion of hematoma volume within adenoma, diameter of the diaphragmatic foramen, and extrasellar extensions) were also evaluated using MRI signal intensity on both T1-and T2-WI.…”

“…The symptoms of pituitary adenomas, such as headache, visual function impairment, and pituitary function insufficiency, usually manifest as compression effects on the dura mater in the sella, the optic chiasm, and the pituitary gland (1)(2)(3)(4). Intratumoral hemorrhages occur frequently and can exacerbate the symptoms of the adenoma, but there are many grades of severity (5,6).…”