• Arman Jahangiri, Jeffrey R Wagner, Aaron T Chin, Sung Won Han, Mai T Tran, Liane M Miller, Maxwell W Tom, Rebecca Chen, Sandeep Kunwar, Lewis Blevins, and Manish K Aghi.
• Department of Neurosurgery and The California Center for Pituitary Disorders (CCPD), University of California at San Francisco (UCSF), San Francisco, USA.
• Clin Neurol Neurosurg. 2015 May 1; 132: 16-20.

IntroductionDue to the high incidence of headaches and pituitary tumors, neurosurgeons often evaluate patients with benign-appearing sellar lesions and headaches without insight into whether the headache is attributable to the lesion. We sought to evaluate the incidence of headache as a presenting complaint in patients undergoing transsphenoidal surgery for various pathologies and to identify factors predicting postoperative improvement.MethodsWe conducted a 5-year retrospective review of our first 1015 transsphenoidal surgeries since establishing a dedicated pituitary center.ResultsOf 1015 patients, 329 (32%) presented with headache. Of these 329 patients, 241 (73)% had headache as their chief complaint. Headache was most common in patients with apoplexy (84%), followed by Rathke's cleft cysts (RCCs) (60%). Multivariate analyses revealed diagnosis (P = 0.001), younger age (P = 0.001), and female gender (P = 0.006) to be associated with headache. Of patients presenting with headaches, 11% reported improvement at 6-week follow-up and 53% improved at 6-month follow-up. Multivariate analyses revealed gross total resection (GTR; P = 0.04) and decreased duration of headache (P = 0.04) to be associated with improvement, while diagnosis, age, gender, lesion size, whether headache was a chief complaint, and location of headache were not associated with improvement (P > 0.05).ConclusionIn analyzing over 1000 consecutive patients undergoing transsphenoidal surgery, younger patients, females, and patients with RCCs and apoplexy were more likely to present with headache. Patients who underwent GTR and had shorter duration of headache were more likely to experience headache improvement. This information can be used to counsel patients preoperatively.Copyright © 2015 Elsevier B.V. All rights reserved.

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