Significant headache improvement after transsphenoidal surgery in patients with small sellar lesions.
OBJECTIVE
Pituitary adenomas represent a large proportion of brain tumors that are increasing in incidence because of improved imaging techniques. Headache is the primary symptom in patients with large tumors (macroadenomas), but is also a symptom in patients with small tumors (microadenomas, tumors < 1.0 cm). The prevalence and optimal treatment of headaches associated with pituitary tumors is still unclear, particularly in cases of microadenoma. If conventional medical management fails, transsphenoidal surgery (TSS) may be considered as an alternative treatment for intractable headaches.


METHODS
The authors conducted a retrospective review of 512 patients who underwent TSS at Oregon Health & Science University between 2001 and 2007; patients with Cushing disease were excluded. The authors identified 41 patients with small pituitary tumors who underwent TSS, and retrospectively evaluated the resolution and/or treatment of headache.


RESULTS
Ninety percent of patients who presented with nonfunctioning microadenomas and Rathke cleft cysts experienced resolution or improvement in their headaches after TSS, and 56% of patients who presented with hyperfunctioning pituitary microadenomas had improvement in their headaches. There were no postoperative complications.


CONCLUSIONS
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.
Fleseriu
Maria
M
Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. fleseriu@ohsu.edu
Yedinak
Christine
C
Campbell
Caitlin
C
Delashaw
Johnny B
JB
D000328:Adult; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000601:surgery; D006261:Headache / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010901:Pituitary Function Tests; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D015175:Prolactinoma / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery*