Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement.
Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement.
复制标题
垂体腺瘤患者经蝶手术后顽固性头痛明显改善；
DOI：
10.1007/s11102-015-0696-8
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发表时间：
2016
期刊：
影响因子：
3.8
通讯作者：
Nakada M.
中科院分区：
文献类型：
--
作者：
Hayashi Y;Kita D;Iwato M;Fukui I;Oishi M;Tsutsui T;Tachibana O;Nakada M.
头痛是原发性和转移性脑肿瘤最常见的症状，也是大型垂体腺瘤的主要症状。然而，小垂体腺瘤患者很少抱怨顽固性头痛，神经外科医生不确定这种小腺瘤是否真的会导致头痛。如果头痛的常规药物治疗证明无效，手术切除腺瘤可以被认为是一种替代的管理strategy.MethodsWe进行了回顾性分析，180例谁接受了经蝶手术（TSS）垂体腺瘤在金泽大学医院2006年和2014年之间。排除急性期瘤内出血患者。我们发现9例顽固性头痛患者的主诉与小垂体腺瘤（直径15.8 ± 2.6 mm，11-20 mm）有关，8例无功能，1例分泌催乳素。术前神经放射学研究和头痛的特点进行了回顾性评估，鞍内压力评价进行TSS在过去的7 patients.ResultsAll 9例患者完全或实质性解决他们以前顽固性头痛TSS后。头痛包括同侧眼痛的腺瘤定位在鞍内的4例和双额叶头痛的5。这些患者的磁共振成像显示垂体孔很小，非常狭窄，只有垂体柄可以通过。CT显示蝶窦鞍底下骨化，鞍前型6例，软骨型3例。7例腺瘤中有囊肿。无海绵窦侵犯。鞍内压平均为41.5 ± 8.5mmHg（34-59），显著高于对照组（n = 12）（22.2 ± 10.6mmHg（16-30））。结论：在本研究中，作者证实了TSS治疗垂体腺瘤相关顽固性头痛的有效性。对于主诉顽固性头痛和患有垂体腺瘤的患者，存在眼部疼痛（尤其是腺瘤同侧）、鞍隔完整性、蝶窦骨化、囊肿或出血以及没有海绵窦浸润是TSS的适应症。
ObjectHeadache is the most common symptom of both primary and metastatic brain tumor, and is generally considered the primary symptom in patients with large pituitary adenomas. However, patients with small pituitary adenomas rarely complain of intractable headache, and neurosurgeons are unsure whether such small adenomas actually contribute to headache. If conventional medical treatments for headache prove ineffective, surgical removal of the adenoma can be considered as an alternative management strategy.MethodsWe conducted a retrospective review of 180 patients who underwent transsphenoidal surgery (TSS) for pituitary adenomas at Kanazawa University Hospital between 2006 and 2014. Patients with acute phase intratumoral hemorrhage were excluded. We identified nine patients with intractable headache as the chief complaint associated with small pituitary adenoma (diameters 15.8 ± 2.6 mm, 11–20 mm), non-functioning in eight, and prolactin-secreting in one. The preoperative neuroradiological studies and headache characteristics were assessed retrospectively, and the intrasellar pressure evaluation was performed during TSS in the last seven patients.ResultsAll nine patients had complete or substantial resolution of their formerly intractable headache after TSS. Headaches consisted of ocular pain ipsilateral to the adenoma localization within the sella in four cases and bifrontal headache in five. Magnetic resonance imaging of these patients revealed small diaphragmatic foramen, which were so narrow that only the pituitary stalk could pass. Computed tomography scans showed ossification beneath the sellar floor in the sphenoid sinus, presellar type in six cases, and choncal type in three. The adenomas included cysts in seven cases. There was no cavernous sinus invasion. Intrasellar pressure measurements averaged 41.5 ± 8.5 mmHg, range 34–59, significantly higher than in control patients without headache (n = 12), namely 22.2 ± 10.6 mmHg (16–30).ConclusionIn this study, the authors demonstrated the validity of TSS in the treatment of intractable headache associated with pituitary adenoma. The presence of ocular pain, especially ipsilateral to the adenoma, integrity of the diaphragm sella, and ossification in the sphenoid sinus, cyst or hemorrhage and the absence of cavernous sinus invasion were the indications for TSS for patients complaining of intractable headache and having pituitary adenomas.