Headache as an indication for surgery in non-functioning pituitary adenoma and Rathke's cleft cyst: A systematic review.

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, especially 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.