Headache Improvement Following Endoscopic Resection of Pituitary Adenomas

BACKGROUND: Headache is a common symptom in patients with pituitary adenomas. Research on whether resection of pituitary adenomas via the endoscopic endo-nasal approach (EEA) affects headaches is limited, and the pathophysiology of headaches associated with pituitary adenomas remains unclear. This study aimed to determine if resection of pituitary adenomas via the EEA improves headaches and investigate factors that may be associated with headaches in patients with pituitary adenoma.METHODS: A prospectively collected database of 122 patients undergoing resection of pituitary adenoma via the EEA was analyzed. Patient-reported headache severity was collected prospectively using the Headache Impact Test (HIT-6) at preoperative baseline and 4 postoperative time points (3 weeks, 6 weeks, 3 months, and 6 months).RESULTS: Adenoma size and subtype, cavernous sinus invasion, and hormonal status were not associated with preoperative headache burden. In patients with preopera-tive headaches (HIT-6 score >36), significant decreases in HIT-6 score were observed postoperatively at 6 weeks (5.5-point improvement, 95% CI 1.27-9.78, P < 0.01), 3 months (3.6-point improvement, 95% CI 0.01-7.18, P < 0.05), and 6 months (7.5-point improvement, 95% CI 3.43-11.46, P < 0.01). The only factor associated with headache improve-ment was cavernous sinus invasion (P [ 0.003). Adenoma size and subtype and hormonal status were not associated with postoperative headache burden.CONCLUSIONS: Resection via the EEA is associated with significant improvement in headache-related impact on patient functioning from =6 weeks after surgery. Pa-tients with cavernous sinus invasion are more likely to experience improvement in headaches. The mechanism of headaches associated with pituitary adenoma still requires clarification.

Automated summary

This study aimed to determine if resection of pituitary adenomas via the endoscopic endo-nasal approach (EEA) improves headaches and investigate factors that may be associated with headaches in patients with pituitary adenoma. The results showed that surgery using this method can significantly improve headaches and patients with cavernous sinus invasion are more likely to experience improvement in headaches.