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J Neurol Surg B Skull Base
DOI: 10.1055/a-2036-0652
Original Article

Headache in Patients with Sellar Disease: Clinicomorphological Predictors of Headache and the Outcome of Endoscopic Transsphenoidal Surgery

Maria Joseph 
1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
2   Department of Neurosurgery, John Hunter Hospital, Newcastle, NSW, Australia
,
Raquel Alvarado
1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
,
Benjamin P. Jonker
3   Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
4   Institute of Academic Surgery and Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney, Australia
5   Brain and Mind Centre, University of Sydney, Australia
,
Mark J. Winder
3   Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
6   St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
,
Peter Earls
1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
7   Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia
,
Raewyn Campbell
1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
8   Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
9   Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
,
Larry H. Kalish
1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
10   Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
11   Faculty of Medicine, University of Sydney, Sydney, Australia
,
Raymond Sacks
1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
9   Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
10   Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
,
Andrew S. Davidson
9   Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
,
Ann McCormack
6   St Vincent's Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
12   Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
13   Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia
,
Richard J. Harvey
1   Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
9   Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Abstract

Objectives Sellar pathologies are frequently found on imaging performed to investigate headache. However, both headache and incidental sellar lesions are common. Hence, this study prospectively examined headache prevalence, phenotype, and severity in patients with sellar pathologies and the impact of transsphenoidal surgery on headache.

Methods Patients undergoing transsphenoidal resection of sellar lesions were consecutively recruited. At baseline, participants were defined as having headache or not and headache phenotype was characterized using validated questionnaires. Headache severity was assessed at baseline and 6 months postoperatively using the Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment Score (MIDAS). Tumor characteristics were defined using radiological, histological, and endocrine factors. Primary outcomes included baseline headache prevalence and severity and headache severity change at 6 months postoperatively. Correlation between headache and radiological, histological, and endocrine characteristics was also of interest.

Results Sixty participants (62% female, 47.1 ± 18.6 years) were recruited. Sixty-three percent possessed baseline headache. HIT-6 scores were higher in patients with primary headache risk factors, including younger age (R2  = −0.417, p = 0.010), smoking history (63.31 ± 7.93 vs 54.44 ± 9.21, p = 0.0060), and family headache history (68.13 ± 7.01 vs 54.94 ± 9.11, p = 0.0030). Headaches were more common in patients with dural invasion (55.70 ± 12.14 vs 47.18 ± 10.15, p = 0.027) and sphenoid sinus invasion (58.87 ± 8.97 vs 51.29 ± 10.97, p = 0.007). Postoperative severity scores improved more with higher baseline headache severity (HIT-6: R2 = −0.682, p < 0.001, MIDAS: R2 = −0.880, p < 0.0010) and dural invasion (MIDAS: −53.00 ± 18.68 vs 12.00 ± 17.54, p = 0.0030).

Conclusions Headaches in sellar disease are likely primary disorders triggered or exacerbated by sellar pathology. These may respond to surgery, particularly in patients with severe headache and dural invasion.

Keywords

primary headache - secondary headache - sellar tumors - pituitary tumors - endoscopic transsphenoidal surgery - dural invasion


Publication History

Received: 17 July 2022

Accepted: 09 February 2023

Accepted Manuscript online:
15 February 2023

Article published online:
20 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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