Abstract Details

Abstract Date: 4/7/2014

Author(s):
Arman Jahangiri
Jeffrey Wagner, BS (San Francisco, CA)
Sung Won Han
Brandon Imber, MS
Sandeep Kunwar, MD
Lewis Blevins, MD (San Francisco , CA)
Manish Aghi, MD, PhD (San Francisco, CA)

Introduction

Because of the high incidence of headaches and pituitary tumors, neurosurgeons are often asked to evaluate patients with benign-appearing sellar lesions and headaches without insight into whether the headache is attributable to the lesion.  We sought to evaluate the incidence of headache as a presenting complaint in over 1000 patients with sellar lesions of variable pathology and to identify factors predicting postoperative improvement.

Methods

We conducted a five-year retrospective review of our first 1015 transsphenoidal surgeries since establishing a pituitary center of expertise.

Results

Of 1015 patients with sellar lesions, 340 presented with headache. Of patients with headache, 30% presented with headache as their only symptom.  Patients with Rathke’s cleft cysts (RCCs) had the highest percentage of headache at 60%, followed by craniopharyngioma (46%) and apoplexy (44%), while endocrine inactive and active adenomas had lower rates of headache (28-29%).  Multivariate analyses revealed diagnosis (P=0.01), younger age (P=0.001), female gender (P=0.002), and recurrent lesions (P=0.04) to be associated with headache, with  lesion size, suprasellar extension, and hypopituitarism not associated. Of patients presenting with headaches, 36% reported improvement of headaches at 6-week follow-up and 47% had improved at the 6-month follow-up.   Multivariate analyses including associated symptoms, duration and location of headache, age, gender, lesion size, and extent of resection revealed only gross total resection (GTR; P=0.04)  and younger age (P=0.03) to be associated with improvement.

Conclusions

In analyzing over 1000 consecutive patients undergoing surgery for sellar lesions, younger patients, females, and patients with RCCs were more likely to present with headache.  Younger patients and patients undergoing GTR were more likely to experience headache improvement.  This information can be used to counsel patients presenting with these common lesions and this common complaint.

Keywords:

Article ID: AA-28834