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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

Authors

  • 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

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

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