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J Neurol Surg B Skull Base 2022; 83(S 02): e360-e366
DOI: 10.1055/s-0041-1729180
Original Article

Headache Before and After Endoscopic Transsphenoidal Pituitary Tumor Surgery: A Prospective Study

Agnes Andersson‡   *
1   Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
,
Tobias Hallén‡   *
1   Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Daniel S. Olsson
3   Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
4   Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
,
Dan Farahmand
1   Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Ann-Charlotte Olofsson
3   Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Eva Jakobsson Ung
3   Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
5   Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
,
Sofie Jakobsson
5   Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
,
Henrik Bergquist
6   Department of ENT/H&N Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
7   Department of Otorhinolaryngology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
,
Gudmundur Johannsson
3   Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
4   Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
,
Oskar Ragnarsson
3   Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
4   Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
,
Thomas Skoglund 
1   Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
› Author Affiliations Funding The study was supported by grants from the Swedish state under an agreement between the Swedish government and County Councils, the ALF-agreement (ALFGBG-719531 and ALFGBG-772591), and by grants from the Health & Medical Care Committee of the Region Västra Götaland, Sweden and The Swedish Society of Medicine (SLS-884901). T.S. reports grants from Health & Medical Care Committee of the Region Västra Götaland, Sweden, during the conduct of the study; personal fees from Lecture fees from Abbott, outside the submitted work.
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Abstract

Objective Headache is a common symptom among patients with pituitary tumors, as it is in the general population. The aim of the study was to investigate headache as a symptom in patients with pituitary tumors before and 6 months after endoscopic transsphenoidal surgery (TSS).

Design This is a prospective observational cohort study.

Setting This study was conducted at university tertiary referral hospital.

Participants A total of 110 adult patients underwent endoscopic TSS for pituitary tumors.

Main Outcome Measures The Migraine Disability Assessment (MIDAS) questionnaire was used before and 6 months after surgery for the assessment of headache. Clinical variables with potential influence on headache were analyzed.

Results Sixty-eight (62%) patients experienced headaches at least once during the 3 months before surgery. Thirty (27%) patients reported disabling headache before surgery, with younger age being an independent associated factor (p < 0.001). In patients with disabling headache before surgery, the median (interquartile range) MIDAS score improved from 78 (27–168) to 16 (2–145; p = 0.049), headache frequency decreased from 45 (20–81) to 14 (4–35) days (p = 0.009), and headache intensity decreased from 6 (5–8) to 5 (4–7) (p = 0.011) after surgery. In total, 16 of the 30 (53%) patients reported a clinically relevant improvement and five (17%) a clinically relevant worsening. Four (5%) patients developed new disabling headache. No predictor for postoperative improvement of headache was identified.

Conclusion In this prospective study, the results show that disabling headache improves following endoscopic TSS in a subset of patients with pituitary tumors. However, no predictive factors for improvement could be identified.

Keywords

pituitary tumor - headache - endoscopic - transsphenoidal - surgery

* These authors contributed equally to this study.




Publication History

Received: 07 January 2021

Accepted: 28 February 2021

Article published online:
29 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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