Sonja Siegel1, Renata Weber Carneiro2, Michael Buchfelder3, Bernadette Kleist1, Agnieszka Grzywotz1, Rolf Buslei4, Ulrike Bingel5, Georg Brabant6, Thomas Schenk7, Ilonka Kreitschmann-Andermahr8. 1. Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany. 2. Siemens Healthcare GmbH, Henkestr, 127, Erlangen, 91052, Germany. 3. Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Schwabachanlage 6, Erlangen, 91031, Germany. 4. Institute of Neuropathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Schwabachanlage 6, Erlangen, 91031, Germany. 5. Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany. 6. Department of Internal Medicine I, University of Luebeck, Ratzeburger Allee 160, Luebeck, 23538, Germany. 7. Department of Psychology, Ludwig-Maximilians University Munich, Leopoldstr. 13, Munich, 80802, Germany. 8. Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany. Ilonka.kreitschmann@uk-essen.de.
Abstract
PURPOSE: Headache is a common presenting feature of patients with pituitary adenomas and other tumors of the sellar region. However, at present, it still is unclear whether the headache is actually caused by the tumor. To explore whether there is a relation, we examined in detail the headache types, their relationship to the underlying pathology, and if the headache responded to neurosurgery in a prospective study design. METHODS: One hundred twelve patients with tumors of the sellar region scheduled for neurosurgery in a single center were analyzed for presence and quality of headache before surgery and at least 3 months after surgery. Patients received headache and depression self-rating inventories, presented on a handheld computer (PainDetect®). Clinical variables thought to impact on headache were analyzed in conjunction with the inventories. RESULTS: Fifty-nine (53%) patients reported headache in the 3 months prior to neurosurgery, 49 (44%) had headache at the time of filling in the questionnaires. The four patients with pituitary apoplexy described thunderclap headache. In the other patients diverse headache types were encountered, most frequently migraine. Untreated gonadotroph deficiency was significantly associated with absence of headache, while none of the other clinical and morphological variables related to headache. Presence of headache and disability due to headache were not significantly reduced after surgery. CONCLUSION: Apart from pituitary apoplexy we detected no specific headache type in our patient group and no significant improvement of headache after neurosurgery. Headache alone constitutes neither a valid diagnostic marker for the presence of tumors of the sellar region nor a sufficient indication for tumor removal.
PURPOSE:Headache is a common presenting feature of patients with pituitary adenomas and other tumors of the sellar region. However, at present, it still is unclear whether the headache is actually caused by the tumor. To explore whether there is a relation, we examined in detail the headache types, their relationship to the underlying pathology, and if the headache responded to neurosurgery in a prospective study design. METHODS: One hundred twelve patients with tumors of the sellar region scheduled for neurosurgery in a single center were analyzed for presence and quality of headache before surgery and at least 3 months after surgery. Patients received headache and depression self-rating inventories, presented on a handheld computer (PainDetect®). Clinical variables thought to impact on headache were analyzed in conjunction with the inventories. RESULTS: Fifty-nine (53%) patients reported headache in the 3 months prior to neurosurgery, 49 (44%) had headache at the time of filling in the questionnaires. The four patients with pituitary apoplexy described thunderclap headache. In the other patients diverse headache types were encountered, most frequently migraine. Untreated gonadotroph deficiency was significantly associated with absence of headache, while none of the other clinical and morphological variables related to headache. Presence of headache and disability due to headache were not significantly reduced after surgery. CONCLUSION: Apart from pituitary apoplexy we detected no specific headache type in our patient group and no significant improvement of headache after neurosurgery. Headache alone constitutes neither a valid diagnostic marker for the presence of tumors of the sellar region nor a sufficient indication for tumor removal.
Entities:
Keywords:
Headache; Neurosurgery; Pituitary adenoma; Sellar region
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