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

Clinical article

Restricted access

Object

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.

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: fleseriu@ohsu.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

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

References

  • 1

    Abe TMatsumoto KKuwazawa JToyoda ISasaki K: Headache associated with pituitary adenomas. Headache 38:7827861998

  • 2

    Arafah BMPrunty DYbarra JHlavin MLSelman WR: The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab 85:178917932000

    • Search Google Scholar
    • Export Citation
  • 3

    Cohan PFoulad AEsposito FMartin NAKelly DF: Symptomatic Rathke's cleft cysts: a report of 24 cases. J Endocrinol Invest 27:9439482004

    • Search Google Scholar
    • Export Citation
  • 4

    Evans RWLevy MJ: Expert opinion: headache and pituitary tumors. Headache 48:2802832008

  • 5

    Ferrante EFerraroni MCastrignano TMenicatti LAnagni MReimondo G: Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors. Eur J Endocrinol 155:8238292006

    • Search Google Scholar
    • Export Citation
  • 6

    Ferrari MDHaan Jvan Seters AP: Bromocriptine-induced trigeminal neuralgia attacks in a patient with a pituitary tumor. Neurology 38:148214841988

    • Search Google Scholar
    • Export Citation
  • 7

    Forsyth PAPosner JB: Headaches in patients with brain tumors: a study of 111 patients. Neurology 43:167816831993

  • 8

    Gabrielli MGasbarrini AFiore GSantarelli LPadalino CDe Martini D: Resolution of migraine with aura after successful treatment of a pituitary microadenoma. Cephalalgia 22:1491502002

    • Search Google Scholar
    • Export Citation
  • 9

    Goadsby PJ: New targets in the acute treatment of headache. Curr Opin Neurol 18:2832882005

  • 10

    Goadsby PJLipton RBFerrari MD: Migraine–current understanding and treatment. N Engl J Med 346:2572702002

  • 11

    Haan JTerwindt GMFerrari MD: Genetics of migraine. Neurol Clin 15:43601997

  • 12

    Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24:1 Suppl91602004

    • Search Google Scholar
    • Export Citation
  • 13

    Jensen RStovner LJ: Epidemiology and comorbidity of headache. Lancet Neurol 7:3543612008

  • 14

    Jiménez-Caballero PE: SUNCT syndrome in a patient with prolactinoma and cabergoline-induced attacks. Cephalalgia 27:76782007

  • 15

    Levy MJBejon PBarakat MGoadsby PJMeeran K: Acromegaly: a unique human headache model. Headache 43:7947972003

  • 16

    Levy MJJager HRPowell MMatharu MSMeeran KGoadsby PJ: Pituitary volume and headache: size is not everything. Arch Neurol 61:7217252004

    • Search Google Scholar
    • Export Citation
  • 17

    Levy MJMatharu MGoadsby PJ: Chronic headache and pituitary tumors. Curr Pain Headache Rep 12:74782008

  • 18

    Levy MJMatharu MSGoadsby PJ: Prolactinomas, dopamine agonists and headache: two case reports. Eur J Neurol 10:1691732003

  • 19

    Levy MJMatharu MSMeeran KPowell MGoadsby PJ: The clinical characteristics of headache in patients with pituitary tumours. Brain 128:192119302005

    • Search Google Scholar
    • Export Citation
  • 20

    Marzocchi NCainazzo MMCatellani DPini LA: A case of a GH-producing pituitary adenoma associated with a unilateral headache with autonomic signs. J Headache Pain 6:1521552005

    • Search Google Scholar
    • Export Citation
  • 21

    Massiou HLaunay JMLevy CEl Amrani MEmperauger BBousser MG: SUNCT syndrome in two patients with prolactinomas and bromocriptine-induced attacks. Neurology 58:169816992002

    • Search Google Scholar
    • Export Citation
  • 22

    Nappi GPerrotta ARossi PSandrini G: Chronic daily headache. Expert Rev Neurother 8:3613842008

  • 23

    Nathoo SClassey JDLevy MJMeeran KPowell MGoadsby PJ: No relationship between vasoactive intestinal polypeptide expression and headache in pituitary tumours. Acta Neurol Scand 111:3173222005

    • Search Google Scholar
    • Export Citation
  • 24

    Negoro KKawai MTada YOgasawara JMisumi SMorimatsu M: A case of postprandial cluster-like headache with prolactinoma: dramatic response to cabergoline. Headache 45:6046062005

    • Search Google Scholar
    • Export Citation
  • 25

    Nishioka HHaraoka JIzawa HIkeda Y: Headaches associated with Rathke's cleft cyst. Headache 46:158015862006

  • 26

    Otsuka FKageyama JOgura TMakino H: Cluster headache dependent upon octreotide injection. Headache 38:6291998

  • 27

    Pareja JASjaastad O: SUNCT syndrome. A clinical review. Headache 37:1952021997

  • 28

    Ward TNSt Germain DLComi RJCromwell LD: Rathke's cleft cyst as a secondary cause of headache: a case report. Cephalalgia 21:9219232001

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 118 118 13
Full Text Views 142 112 2
PDF Downloads 110 88 3
EPUB Downloads 0 0 0

PubMed

Google Scholar