Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement.
BACKGROUND
Due to the high incidence of headaches and pituitary tumors, neurosurgeons often evaluate patients with benign-appearing sellar lesions and headaches without insight into whether the headache is attributable to the lesion. We sought to evaluate the incidence of headache as a presenting complaint in patients undergoing transsphenoidal surgery for various pathologies and to identify factors predicting postoperative improvement.


METHODS
We conducted a 5-year retrospective review of our first 1015 transsphenoidal surgeries since establishing a dedicated pituitary center.


RESULTS
Of 1015 patients, 329 (32%) presented with headache. Of these 329 patients, 241 (73)% had headache as their chief complaint. Headache was most common in patients with apoplexy (84%), followed by Rathke's cleft cysts (RCCs) (60%). Multivariate analyses revealed diagnosis (P = 0.001), younger age (P = 0.001), and female gender (P = 0.006) to be associated with headache. Of patients presenting with headaches, 11% reported improvement at 6-week follow-up and 53% improved at 6-month follow-up. Multivariate analyses revealed gross total resection (GTR; P = 0.04) and decreased duration of headache (P = 0.04) to be associated with improvement, while diagnosis, age, gender, lesion size, whether headache was a chief complaint, and location of headache were not associated with improvement (P > 0.05).


CONCLUSIONS
In analyzing over 1000 consecutive patients undergoing transsphenoidal surgery, younger patients, females, and patients with RCCs and apoplexy were more likely to present with headache. Patients who underwent GTR and had shorter duration of headache were more likely to experience headache improvement. This information can be used to counsel patients preoperatively.
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Arman
A
Jahangiri
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Jeffrey R
JR
Wagner
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Aaron T
AT
Chin
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Sung Won
SW
Han
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Mai T
MT
Tran
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Liane M
LM
Miller
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Maxwell W
MW
Tom
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Rebecca
R
Chen
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Sandeep
S
Kunwar
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
Lewis
L
Blevins
Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA. Electronic address: AghiM@neurosurg.ucsf.edu.
Manish K
MK
Aghi
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010900:Pituitary Diseases / Q000150:complications* / Q000453:epidemiology* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
Headaches; Pituitary tumors; Transsphenoidal surgery