뇌하수체 선종에 대한 경접형동 수술적 제거 후 발생한 두통

Newly developing headache following transsphenoidal approach for pituitary adenoma: A possible explanation of the pathophysiology of a headache associated with the pituitary tumor

There have been numerous reports of headache associated with pituitary tumors. Most of them were described based on the evaluation of pre-operative degree of headache, the anatomic distortion around the sellar area, and chemical changes. Herein, the authors report a unique experience that headache developed after the second transsphenoidal approach (TSA), in which not occurred after the first TSA. A-47-year-old female with a visual disturbance, having a pituitary tumor which expanded superiorly beyond optic chiasm admitted. The surgery underwent via TSA with the aid of an endoscope. On post-operative magnetic resonance imaging, there left half reduced tumor around the suprasellar region, without achieving satisfactory visual improvement. Additional surgery for the removal of the remaining tumor underwent using the same corridor in a week. In the second surgery, a thin membrane was descended enough to reach the sellar floor following total removal of the suprasellar mass. After the second surgery, her recovery was uneventful except complaining of severe headache that had not been after the first surgery. This phenomenon of exposing and stretching of basal arachnoid membrane seems to be a certain explanation for headache development in the patients with a pituitary tumor.