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Abstract：
BACKGROUND: Headache is a common occurrence after endoscopic endonasal surgery (EES) for pituitary adenomas and significantly impacts the quality of life of patients. This study aims to investigate the effectiveness of nasal irrigation in relieving postoperative headache after EES.
METHODS: A retrospective analysis was conducted on a cohort of 101 patients (Cohort I) who underwent EES for pituitary adenomas to explore the risk factors associated with postoperative headache. Another cohort of 72 patients (Cohort II) who received adjuvant nasal irrigation following surgery was enrolled for further analysis. The Headache Impact Test (HIT-6) was used to score the severity of headache, and patients with a HIT score > 55 were classified as having headache.
RESULTS: In Cohort I, 21.78% of patients experienced headache one month after EES, which decreased to 5.94% at the three-month follow-up. Multivariate analysis revealed that postoperative nasal sinusitis (OR = 3.88, 95%CI 1.16-13.03, p = 0.028) and Hardy\'s grade C-D (OR = 10.53, 95%CI 1.02-109.19, p = 0.049) independently predicted the presence of postoperative headache at one month. At the three-month follow-up, patients with sinusitis had higher HIT-6 scores compared to those without sinusitis (44.43 ± 9.78 vs. 39.72 ± 5.25, p = 0.017). In Cohort II, the incidence of sinusitis at three months was significantly lower than that in Cohort I (p = 0.028). Importantly, both the incidence of headache and HIT-6 scores in Cohort II were significantly lower than those in Cohort I at the one- and three-month follow-ups.
CONCLUSIONS: Postoperative sinusitis is an independent risk factor for the development of headache following EES for pituitary adenomas. Prophylactic nasal irrigation helps relieve postoperative headache, possibly by preventing the occurrence of sinusitis.
METHODS: A retrospective analysis was conducted on a cohort of 101 patients (Cohort I) who underwent EES for pituitary adenomas to explore the risk factors associated with postoperative headache. Another cohort of 72 patients (Cohort II) who received adjuvant nasal irrigation following surgery was enrolled for further analysis. The Headache Impact Test (HIT-6) was used to score the severity of headache, and patients with a HIT score > 55 were classified as having headache.
RESULTS: In Cohort I, 21.78% of patients experienced headache one month after EES, which decreased to 5.94% at the three-month follow-up. Multivariate analysis revealed that postoperative nasal sinusitis (OR = 3.88, 95%CI 1.16-13.03, p = 0.028) and Hardy\'s grade C-D (OR = 10.53, 95%CI 1.02-109.19, p = 0.049) independently predicted the presence of postoperative headache at one month. At the three-month follow-up, patients with sinusitis had higher HIT-6 scores compared to those without sinusitis (44.43 ± 9.78 vs. 39.72 ± 5.25, p = 0.017). In Cohort II, the incidence of sinusitis at three months was significantly lower than that in Cohort I (p = 0.028). Importantly, both the incidence of headache and HIT-6 scores in Cohort II were significantly lower than those in Cohort I at the one- and three-month follow-ups.
CONCLUSIONS: Postoperative sinusitis is an independent risk factor for the development of headache following EES for pituitary adenomas. Prophylactic nasal irrigation helps relieve postoperative headache, possibly by preventing the occurrence of sinusitis.
摘要：
背景：头痛是垂体腺瘤的鼻内镜手术（EES）后的常见病，严重影响患者的生活质量。本研究旨在探讨鼻腔冲洗在缓解EES术后头痛中的有效性。
方法：对101例因垂体腺瘤而接受EES的患者（队列I）进行回顾性分析，以探讨与术后头痛相关的危险因素。另一组72名患者(队列II)在手术后接受辅助鼻冲洗,用于进一步分析。头痛影响测试（HIT-6）用于对头痛的严重程度进行评分，HIT评分>55的患者被归类为头痛。
结果：在队列I中，21.78%的患者在EES后一个月出现头痛，在三个月的随访中下降到5.94%。多因素分析显示，术后鼻窦炎（OR=3.88，95CI1.16-13.03，p=0.028）和Hardy'sC-D分级（OR=10.53，95CI1.02-109.19，p=0.049）独立预测了术后1个月头痛的存在。在三个月的随访中，与没有鼻窦炎的患者相比，鼻窦炎患者的HIT-6评分更高（44.43±9.78vs.39.72±5.25，p=0.017）。在队列II中，3个月时鼻窦炎的发生率明显低于I组(p=0.028).重要的是,在1个月和3个月的随访中,队列II的头痛发生率和HIT-6评分均显著低于队列I.
结论：术后鼻窦炎是垂体腺瘤EES后发生头痛的独立危险因素。预防性鼻腔冲洗有助于缓解术后头痛，可能是通过预防鼻窦炎的发生。
方法：对101例因垂体腺瘤而接受EES的患者（队列I）进行回顾性分析，以探讨与术后头痛相关的危险因素。另一组72名患者(队列II)在手术后接受辅助鼻冲洗,用于进一步分析。头痛影响测试（HIT-6）用于对头痛的严重程度进行评分，HIT评分>55的患者被归类为头痛。
结果：在队列I中，21.78%的患者在EES后一个月出现头痛，在三个月的随访中下降到5.94%。多因素分析显示，术后鼻窦炎（OR=3.88，95CI1.16-13.03，p=0.028）和Hardy'sC-D分级（OR=10.53，95CI1.02-109.19，p=0.049）独立预测了术后1个月头痛的存在。在三个月的随访中，与没有鼻窦炎的患者相比，鼻窦炎患者的HIT-6评分更高（44.43±9.78vs.39.72±5.25，p=0.017）。在队列II中，3个月时鼻窦炎的发生率明显低于I组(p=0.028).重要的是,在1个月和3个月的随访中,队列II的头痛发生率和HIT-6评分均显著低于队列I.
结论：术后鼻窦炎是垂体腺瘤EES后发生头痛的独立危险因素。预防性鼻腔冲洗有助于缓解术后头痛，可能是通过预防鼻窦炎的发生。
