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

Clinical article

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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.


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.


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.


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.

Abbreviations used in this paper: DA = dopamine agonist; GH = growth hormone; NFA = nonfunctioning microadenoma; RCC = Rathke cleft cyst; SUNCT = short-lasting unilateral neuralgiform headache with conjuntival injection and tearing; TSS = transsphenoidal surgery.

Article Information

Address correspondence to: Maria Fleseriu, M.D., Department of Neurological Surgery, CH8N, Oregon Health & Science University, 3303 South West Bond Avenue, Portland, Oregon 97239. email:

© AANS, except where prohibited by US copyright law.



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    Graph demonstrating significant changes in headache intensity after TSS. HA = headache; PRL = prolactin.


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