Andersson Agnes, Hallén Tobias, Olsson Daniel S, Farahmand Dan, Olofsson Ann-Charlotte, Jakobsson Ung Eva, Jakobsson Sofie, Bergquist Henrik, Johannsson Gudmundur, Ragnarsson Oskar, Skoglund Thomas
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Neurol Surg B Skull Base. 2021 May 29;83(Suppl 2):e360-e366. doi: 10.1055/s-0041-1729180. eCollection 2022 Jun.
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). This is a prospective observational cohort study. This study was conducted at university tertiary referral hospital. A total of 110 adult patients underwent endoscopic TSS for pituitary tumors. 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. 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 ( < 0.001). In patients with disabling headache before surgery, the median (interquartile range) MIDAS score improved from 78 (27-168) to 16 (2-145; = 0.049), headache frequency decreased from 45 (20-81) to 14 (4-35) days ( = 0.009), and headache intensity decreased from 6 (5-8) to 5 (4-7) ( = 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. 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.
头痛是垂体瘤患者常见的症状，在普通人群中也是如此。本研究的目的是调查垂体瘤患者在内镜经蝶窦手术（TSS）前及术后6个月时头痛这一症状。 这是一项前瞻性观察队列研究。 本研究在大学三级转诊医院进行。 共有110例成年患者接受了垂体瘤内镜TSS手术。 术前及术后6个月使用偏头痛残疾评估（MIDAS）问卷评估头痛情况。分析了对头痛有潜在影响的临床变量。 68例（62%）患者在手术前3个月内至少经历过一次头痛。30例（27%）患者术前报告有失能性头痛，年龄较小是独立相关因素（<0.001）。术前有失能性头痛的患者，术后MIDAS评分中位数（四分位间距）从78（27 - 168）改善至16（2 - 145；=0.049），头痛频率从45（20 - 81）天降至14（4 - 35）天（=0.009），头痛强度从6（5 - 8）降至5（4 - 7）（=0.011）。30例患者中共有16例（53%）报告有临床相关改善，5例（17%）有临床相关恶化。4例（5%）患者出现新的失能性头痛。未发现术后头痛改善的预测因素。 在这项前瞻性研究中，结果表明，部分垂体瘤患者在内镜TSS术后失能性头痛有所改善。然而，未发现改善的预测因素。
