Prevention of headache after retrosigmoid removal of acoustic tumors.
OBJECTIVE
To demonstrate a causal relationship between bone dust and the development of headache after retrosigmoid removal of acoustic neuromas.


METHODS
The study design was both retrospective (group I) and prospective (groups 2 and 3).


METHODS
Tertiary Care Referral Center/Outpatient Data Collection.


METHODS
Eighty-four consecutive patients underwent surgery at the Mount Sinai Medical Center in New York by the same surgical team.


METHODS
All patients underwent retrosigmoid removal of acoustic neuromas via the following methods: group 1, standard excision; group 2, excision and cranioplasty; group 3, excision, cranioplasty, and residue trapping.


METHODS
Presence or absence of postoperative headache.


RESULTS
In all, 43 patients (51%) reported postoperative headache. By groups, headache incidence was 64% for group 1 (43% grade 3-4), 81% for group 2 (37% grade 3-4), and 10% (all grade 1) for group 3. Differences with respect to headache incidence and severity were statically significant between groups 1 and 3, and between groups 2 and 3 (p < 0.001).


CONCLUSIONS
Free circulation of bone dust into the posterior fossa during intradural drilling of the internal auditory canal may be the most important factor in the development of headache after this surgical procedure.
Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York, USA.
P J
PJ
Catalano
O
O
Jacobowitz
K D
KD
Post
D000293:Adolescent; D000328:Adult; D000368:Aged; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006261:Headache / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000159:Vestibulocochlear Nerve / Q000473:pathology / Q000601:surgery*