Introduction: Uncertainty surrounds the benefit of surgery for relieving headache in patients with small pituitary lesions. This study addresses this by analyzing patterns and predictors of headache relief in pituitary adenomas and Rathke cleft cysts (RCCs) ≤1 centimeter.
Methods: We reviewed the records of 465 surgically resected pituitary growths (306 functional adenomas, 27 nonfunctional adenomas, 132 RCCs) ≤1cm. Univariate and multivariate analyses were performed to determine predictors of headache resolution within 6 months postoperatively. Age, sex, and variables with a univariate p< 0.1 (number and usage of preoperative medications, size >5mm) were included in multivariate analysis.
Results: Mean age and lesion size were 43 years and 6.5 millimeters respectively. 74% were female. 66.7% endorsed preoperative headache. Headache was more common in females (70.8% vs. 54.6%, p=0.001). Functional adenomas reported headache less often than nonfunctional adenomas and RCCs (63.1% vs. 73.6%, p=0.023). Preoperative headache rates varied by lesion type (70.7% prolactinoma vs. 72.7% RCC vs. 55.2% corticotroph vs. 77.8% nonfunctional vs. 56.0% plurihormonal vs. 47.8% somatotroph vs. 33.3% thyrotroph vs. 100% functional gonadotroph; p=0.012). Overall, headache resolved in 52.6% of patients. Patients with lesions >5mm were more likely to experience headache resolution (57.1% vs. 43.2%, p=0.031). This remained a significant predictor in univariate (OR=1.75 [1.05-2.95, 95% CI], p=0.032) and multivariate (OR=1.71 [1.01-2.91, 95% CI], p=0.047) analyses. Preoperative headache medication usage was associated with lower headache resolution rates (37.6% vs. 60.5%, p< 0.001; univariate OR=0.39 [0.23-0.66, 95% CI], p< 0.001; multivariate OR=0.63 [0.27-1.59, 95% CI], p=0.3). Patients with persistent postoperative headache utilized a higher mean number of headache medications preoperatively (0.75 vs. 0.34, p< 0.001; univariate OR=0.59 [0.42-0.79, 95% CI], p=0.001; multivariate OR=0.74 [0.42-1.13, CI 95%], p=0.2).
Conclusion : Approximately half of patients with pituitary lesions < 1cm experienced postoperative headache resolution, with size >5mm predicting resolution. Clinicians should consider these findings when discussing expectations with patients.
.jpg)
