Comparison of postoperative headache after retrosigmoid approach: vestibular nerve section versus vestibular schwannoma resection.
OBJECTIVE
To evaluate intradural drilling as a mechanism for the development of postoperative headache after retrosigmoid craniectomy.


METHODS
A retrospective review of charts was performed on 565 retrosigmoid approaches to the cerebellopontine angle performed between January 1980 and January 1998. Patients treated with retrosigmoid vestibular nerve section without intradural drilling were compared with patients who underwent retrosigmoid removal of vestibular schwannomas in which intradural drilling was performed for exposure of the internal auditory canal.


METHODS
Private practice tertiary referral center.


METHODS
Consecutive patients undergoing retrosigmoid approach between January 1980 and January 1998 were reviewed.


METHODS
The presence of headache, duration of headache, and severity of headache were noted.


RESULTS
In this large series, 54% of patients experienced headaches after vestibular schwannoma removal, and 5% of patients experienced headaches after vestibular nerve section (p < 0.01, chi-square).


CONCLUSIONS
Postoperative headache is not a characteristic of retrosigmoid craniectomy in the absence of intradural drilling. Intradural drilling is a probable cause of headache after the retrosigmoid approach. Cranioplasty is not necessary to prevent a high incidence of postoperative headache after retrosigmoid approach.
Jackson
C G
CG
The Otology Group, Nashville, Tennessee, USA.
McGrew
B M
BM
Forest
J A
JA
Hampf
C R
CR
Glasscock
M E
ME
Brandes
J L
JL
Hanson
M B
MB
D000293:Adolescent; D000368:Aged; D005260:Female; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications* / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013701:Temporal Bone / Q000601:surgery*; D014725:Vestibular Nerve / Q000601:surgery*; D014722:Vestibule, Labyrinth / Q000601:surgery*