Background: Headache is the common symptom reported by patients with pituitary lesions. However, its true mechanism and provocative factors are still unknown. For those with pituitary lesion and only present headache, conservative treatment is the reasonable choice but not able to improve their life quality. Endoscopic endonasal surgery has been an efficient treatment modality for pituitary lesions and might play more aggressive role in the management of headache.
Methods: 800 surgical cases of endonasal endoscopic approach from 2015 to 2023 in Taipei Veterans General Hospital were reviewed. Patients who accepted surgeries only for intractable headache were selected. Those with lesion larger than 1.0 cm, cavernous sinus invasion, apoplexy, Cushing's disease and hormonal insufficiency were excluded. Before the surgical treatment, all selected patients had visited the neurologists for headache survey.
Results: 10 patients (9 female, 1 male) were enrolled in this series. The average age was 28.8 years old. 9 (90%) patients had significant improvement of headache after the surgeries but still one patient suffered the same headache as pre-op status. The pathologies included 6 Rathke’s cleft cyst, 2 lactotroph adenoma, 1 mammosomatotroph adenoma and 2 non-tumorous adenohypophyseal tissue.
Conclusions: In this series, endoscopic endonasal surgery provided excellent outcome to treat intractable headache related to microadenoma or small pituitary lesion. Young female patients with Rathke’s cleft cyst and functional adenoma (Lactotroph and GH-secreting) were the most with intractable headache in our series. Even though endonasal surgery has privileges to treat pituitary lesions, headache as the primary surgical indication should be more carefully evaluated.