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Abstract：
Objectives Sellar pathologies are frequently found on imaging performed to investigate headache. However, both headache and incidental sellar lesions are common. Hence, this study prospectively examined headache prevalence, phenotype, and severity in patients with sellar pathologies and the impact of transsphenoidal surgery on headache. Methods Patients undergoing transsphenoidal resection of sellar lesions were consecutively recruited. At baseline, participants were defined as having headache or not and headache phenotype was characterized using validated questionnaires. Headache severity was assessed at baseline and 6 months postoperatively using the Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment Score (MIDAS). Tumor characteristics were defined using radiological, histological, and endocrine factors. Primary outcomes included baseline headache prevalence and severity and headache severity change at 6 months postoperatively. Correlation between headache and radiological, histological, and endocrine characteristics was also of interest. Results Sixty participants (62% female, 47.1 ± 18.6 years) were recruited. Sixty-three percent possessed baseline headache. HIT-6 scores were higher in patients with primary headache risk factors, including younger age (R 2 = -0.417, p = 0.010), smoking history (63.31 ± 7.93 vs 54.44 ± 9.21, p = 0.0060), and family headache history (68.13 ± 7.01 vs 54.94 ± 9.11, p = 0.0030). Headaches were more common in patients with dural invasion (55.70 ± 12.14 vs 47.18 ± 10.15, p = 0.027) and sphenoid sinus invasion (58.87 ± 8.97 vs 51.29 ± 10.97, p = 0.007). Postoperative severity scores improved more with higher baseline headache severity (HIT-6: R 2 = -0.682, p < 0.001, MIDAS: R 2 = -0.880, p < 0.0010) and dural invasion (MIDAS: -53.00 ± 18.68 vs 12.00 ± 17.54, p = 0.0030). Conclusion Headaches in sellar disease are likely primary disorders triggered or exacerbated by sellar pathology. These may respond to surgery, particularly in patients with severe headache and dural invasion.
摘要：
目的在进行头痛的影像学检查中经常发现鞍区病变。然而,头痛和偶发性鞍区病变都很常见。因此，这项研究前瞻性地检查了头痛的患病率，表型,鞍区病变患者的严重程度以及经蝶窦手术对头痛的影响。方法连续招募经蝶入路切除鞍区病变的患者。在基线,参与者被定义为是否有头痛,并使用经过验证的问卷对头痛表型进行了表征.使用头痛影响测试-6（HIT-6）和偏头痛残疾评估评分（MIDAS）在基线和术后6个月评估头痛严重程度。肿瘤特征使用放射学定义，组织学,和内分泌因素。主要结果包括基线头痛患病率和严重程度以及术后6个月头痛严重程度的变化。头痛和放射学之间的相关性，组织学,和内分泌特征也感兴趣。结果60名参与者（62%为女性，47.1±18.6年）被招募。63％的人患有基线头痛。原发性头痛危险因素患者的HIT-6评分较高,包括年龄较小（R2=-0.417，p=0.010），吸烟史（63.31±7.93vs54.44±9.21，p=0.0060），家族头痛史（68.13±7.01vs54.94±9.11，p=0.0030）。头痛在硬膜侵犯（55.70±12.14vs47.18±10.15，p=0.027）和蝶窦侵犯（58.87±8.97vs51.29±10.97，p=0.007）的患者中更为常见。术后严重程度评分随着基线头痛严重程度的升高而改善（HIT-6：R2=-0.682，p<0.001，MIDAS：R2=-0.880，p<0.0010）和硬脑膜侵犯（MIDAS：-53.00±18.68vs12.00±17.54，p=0.0030）。结论鞍病头痛可能是鞍病病理引发或加重的原发性疾病。这些可能对手术有反应，特别是严重头痛和硬脑膜侵犯的患者。
