Technical Modifications of Suboccipital Craniectomy for Prevention of Postoperative Headache

 

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A retrospective review of 53 consecutive patients who underwent a retrosigmoid vestibular nerve section (VNS) or microvascular decompression (MVD) through a modified suboccipital craniectomy with a minimum follow-up of 2 years was performed. Technical modifications to the suboccipital craniectomy included a skin incision designed to avoid the lesser and greater occipital nerves; a small, 2-cm diameter craniectomy with no intradural drilling of bone; and a simplified closure to prevent muscle adhesion to dura without the need for cranioplasty. The presence, duration, and severity of postoperative headache were the primary outcome measures. Craniectomy-related complications, operative time, and length of hospital stay were also reviewed. The incidence of postoperative headache after suboccipital craniectomy was 7.5% at 3 months (4/53), 3.8% at 1 year (2/53), and 3.8% at 2 years (2/53). Complications related to craniectomy included cerebrospinal fluid leakage (5.7%), aseptic meningitis (1.9%), and superficial wound infection (1.9%). The mean operative time was 145 and 98 minutes for VNS and MVD, respectively. The mean hospital stay was 2.2 and 3.6 days for VNS and MVD, respectively. Technical modifications of suboccipital craniectomy during retrosigmoid VNS and MVD lowered the incidence of postoperative headache and craniectomy-related complications and had no adverse effect on operative time or length of hospital stay.

REFERENCES

• 1 Levo H, Pyykko I, Blomstedt G. Postoperative headache after surgery for vestibular schwannoma.  Ann Otol Rhinol Laryngol. 2000;  109 853-858
  PubMedGoogle Scholar
• 2 Hanson M B, Glasscock III M E, Brandes J L, Jackson C G. Medical treatment of headache after suboccipital acoustic tumor removal.  Laryngoscope. 1998;  108 1111-1114
  PubMedGoogle Scholar
• 3 Driscoll C L, Beatty C W. Pain after acoustic neuroma surgery.  Otolaryngol Clin North Am. 1997;  30 893-903
  PubMedGoogle Scholar
• 4 Pedrosa C A, Ahern D K, McKenna M J, Ojemann R G, Acquadro M A. Determinants and impact of headache after acoustic neuroma surgery.  Am J Otol. 1994;  15 793-797
  PubMedGoogle Scholar
• 5 Harner S G, Beatty C W, Ebersold M J. Headache after acoustic neuroma excision.  Am J Otol. 1993;  14 552-555
  PubMedGoogle Scholar
• 6 Schessel D A, Nedzelski J M, Rowed D W, Feghali J G. Pain after surgery for acoustic neuroma.  Otolaryngol Head Neck Surg. 1992;  107 424-429
  PubMedGoogle Scholar
• 7 Catalano P J, Jacobowitz O, Post K D. Prevention of headache after retrosigmoid removal of acoustic tumors.  Am J Otol. 1996;  17 904-908
  PubMedGoogle Scholar
• 8 Jackson C G, McGrew B M, Forest J A et al.. Comparison of postoperative headache after retrosigmoid approach: vestibular nerve section versus vestibular schwannoma resection.  Am J Otol. 2000;  21 412-416
  PubMedGoogle Scholar
• 9 Silverstein H, Norrell H, Smouha E, Jones R, Rosenberg S. An evolution of approach in vestibular neurectomy.  Otolaryngol Head Neck Surg. 1990;  102 374-381
  PubMedGoogle Scholar
• 10 McKenna M J, Nadol Jr J B, Ojemann R G, Halpin C. Vestibular neurectomy: retrosigmoid-intracanalicular versus retrolabyrinthine approach.  Am J Otol. 1996;  17 253-258
  PubMedGoogle Scholar
• 11 Glasscock III M E, Thedinger B A, Cueva R A, Jackson C G. An analysis of the retrolabyrinthine vs. the retrosigmoid vestibular nerve section.  Otolaryngol Head Neck Surg. 1991;  104 88-95
  PubMedGoogle Scholar
• 12 Lovely T J, Lowry D W, Jannetta P J. Functional outcome and the effect of cranioplasty after retromastoid craniectomy for microvascular decompression.  Surg Neurol. 1999;  51 191-197
  PubMedGoogle Scholar
• 13 Wazen J J, Sisti M, Lam S M. Cranioplasty in acoustic neuroma surgery.  Laryngoscope. 2000;  110 1294-1297
  CrossrefPubMedGoogle Scholar
• 14 Feghali J G, Elowitz E H. Split calvarial graft cranioplasty for the prevention of headache after retrosigmoid resection of acoustic neuromas.  Laryngoscope. 1998;  108 1450-1452
  PubMedGoogle Scholar
• 15 Soumekh B, Levine S C, Haines S J, Wulf J A. Retrospective study of post-craniotomy headaches in suboccipital approach: diagnosis and management.  Am J Otol. 1996;  17 617-619
  PubMedGoogle Scholar
• 16 Harner S G, Beatty C W, Ebersold M J. Impact of cranioplasty on headache after acoustic neuroma removal.  Neurosurgery. 1995;  36 1097-1100
  PubMedGoogle Scholar
• 17 Schessel D A, Rowed D W, Nedzelski J M, Feghali J G. Postoperative pain following excision of acoustic neuroma by the suboccipital approach: observations on possible cause and potential amelioration.  Am J Otol. 1993;  14 491-494
  PubMedGoogle Scholar
• 18 Silverstein H, Norrell H, Haberkamp T. A comparison of retrosigmoid IAC, retrolabyrinthine, and middle fossa vestibular neurectomy for treatment of vertigo.  Laryngoscope. 1987;  97 165-173
  PubMedGoogle Scholar
• 19 Kimmel D L. Innervation of spinal dura mater and dura mater of the posterior cranial fossa.  Neurology. 1961;  11 800-809
  PubMedGoogle Scholar

Joung H LeeM.D. 

Department of Neurological Surgery, The Cleveland Clinic Foundation

S-80, 9500 Euclid Ave.

Cleveland, OH 44195

Email: leej@ccf.org