2025 Poster Presentations
P206: HEADACHE AS AN INDICATION FOR SURGERY IN NON-FUNCTIONING PITUITARY ADENOMA AND RATHKE'S CLEFT CYST: A SYSTEMATIC REVIEW
Adrianna Wierzbicka, MD1; Hediye Gholamshahi, MD, MPH2; Alireza Soltani Khaboushan, MD, MPH2; Farhang Rashidi, MD, MPH2; Mohammadmahdi Sabahi, MD, MPH1; Mohammad Mofatteh, PhD, MPH, PGCert, TLHE, MSc3,4; Anam Baig, DO5; Badih Adada, MD1; Hamid Borghei-Razavi, MD1; 1Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA; 2Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran; 3School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK; 4Neuro International Collaboration (NIC), London, UK; 5Department of Neurology, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
Purpose: Headaches are a common presentation in clinical practice, often necessitating further evaluation and management. This study aims to comprehensively analyze available literature regarding headaches as an absolute surgical indication for patients with nonfunctioning pituitary adenomas (NFPAs) and Rathke's cleft cysts (RCCs), shedding light on postoperative headache resolution, and surgical complications.
Method: Following PRISMA guidelines, PubMed, Scopus, Embase, and Web of Science were searched until October 10th, 2023, using specified keywords. Inclusion criteria involved studies describing patients with NFPA or RCC, where headache was the sole surgical indication. Data were extracted, and quality assessed using the Joanna Briggs Institute (JBI) checklist.
Results: A total of 13 studies met the inclusion criteria, comprising 183 individuals who underwent surgical intervention for headaches caused by NFPA (n=111) or RCC (n=75). The majority of patients experienced headache improvement (75.8%), while persistent headaches were noted in 19.8%, and worsening in 4.3%. Headache recurrence was infrequent (7.1%), and postoperative complications including transient diabetes insipidus (29.4%), cerebrospinal fluid leak (17.6%), postoperative infection (17.6%), and adrenal insufficiency (17.6%) were reported. Quality assessment using JBI checklists indicated variable risk of bias across studies.
Conclusion: Surgical interventions significantly improved headache resolution in patients with NFPAs and RCCs, with few recurrences and manageable complications. Further prospective research with standardized protocols and long-term follow-up is essential to validate headaches as a sole indication for surgery in these patients and optimize outcomes.
