Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Pituitary. 2024 Oct;27(5):635-643. doi: 10.1007/s11102-024-01401-3. Epub 2024 May 20.
To study the long-term effect of transsphenoidal surgery (TSS) on headache in patients with non-functioning pituitary adenoma (NFPA) and identify factors predicting headache relief following TSS.
We evaluated headache in 101 consecutive patients with NFPA who underwent TSS from September 2015 to December 2021, preoperatively and 12-months post-surgery, by using the Migraine Disability Assessment (MIDAS) questionnaire. Health-related quality of life (QoL) was assessed using the EQ-5D visual analogue scale (EQ-VAS).
Of 101 patients, 27 (27%) experienced disabling preoperative headache. Among these, the median total MIDAS score improved from 60 (interquartile range (IQR): 19-140) to 10 (IQR: 0-49) (P = 0.004). Additionally, headache frequency over a 90-day period decreased from 45 (IQR: 25-83) to 6 (IQR: 3-36) days (P = 0.002), and headache intensity decreased from 5 (IQR: 4-7) to 4 (IQR: 2-7) (P = 0.016) at 12-months post-surgery. At 12 months post-surgery, 18 (67%) of 27 patients with preoperatively disabling headache showed clinically relevant improvement of their headache, 4 (15%) showed deterioration, and 5 (19%) remained unchanged. In patients with clinically relevant improvement of their headache, the EQ-VAS score improved from 50 (IQR: 30 - 7) to 80 (IQR: 65-86) (P < 0.001). Of the 74 patients with no preoperative headache, 11 (15%) developed postoperative headache. We identified no clinical factors predicting postoperative headache relief.
The study supports that clinically significant and long-lasting improvements of disabling headache and QoL can be achieved with TSS in a substantial number of patients with NFPA.
研究经蝶窦手术（TSS）对无功能垂体腺瘤（NFPA）患者头痛的长期影响，并确定 TSS 后头痛缓解的预测因素。
我们评估了 2015 年 9 月至 2021 年 12 月期间 101 例连续接受 TSS 的 NFPA 患者的头痛情况，使用偏头痛残疾评估（MIDAS）问卷在术前和术后 12 个月进行评估。使用 EQ-5D 视觉模拟量表（EQ-VAS）评估健康相关生活质量（QoL）。
在 101 例患者中，27 例（27%）患者术前有中重度头痛。其中，MIDAS 总分中位数从 60（四分位距（IQR）：19-140）改善至 10（IQR：0-49）（P=0.004）。此外，90 天内头痛发作频率从 45（IQR：25-83）减少至 6（IQR：3-36）天（P=0.002），头痛强度从 5（IQR：4-7）降低至 4（IQR：2-7）（P=0.016）。术后 12 个月，27 例术前有中重度头痛的患者中，18 例（67%）头痛明显改善，4 例（15%）恶化，5 例（19%）无变化。头痛明显改善的患者，EQ-VAS 评分从 50（IQR：30-7）改善至 80（IQR：65-86）（P<0.001）。74 例术前无头痛的患者中，11 例（15%）术后出现头痛。我们没有发现预测术后头痛缓解的临床因素。
本研究支持 TSS 可显著改善大多数 NFPA 患者的中重度头痛，并长期改善生活质量。
