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Dispersed Bone Spicules as a Cause of Postoperative Headache after Retrosigmoid Vestibular Schwannoma Surgery: A Myth?
Ren, Yin; McDonald, Marin A; Manning, Paul; MacDonald, Bridget V; Schwartz, Marc S; Friedman, Rick A; Harris, Jeffrey P.
Affiliation
  • Ren Y; Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
  • McDonald MA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States.
  • Manning P; Department of Radiology, University of California San Diego, La Jolla, California, United States.
  • MacDonald BV; Department of Radiology, University of California San Diego, La Jolla, California, United States.
  • Schwartz MS; Department of Otolaryngology Head and Neck Surgery, University of California Davis, Sacramento, California, United States.
  • Friedman RA; Department of Neurosurgery, University of California San Diego, La Jolla, California, United States.
  • Harris JP; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States.
J Neurol Surg B Skull Base ; 83(4): 374-382, 2022 Aug.
Article in En | MEDLINE | ID: mdl-35903655
Objectives Dispersion of bone dust in the posterior fossa during retrosigmoid craniectomy for vestibular schwannoma (VS) resection could be a source of meningeal irritation and lead to development of persistent postoperative headaches (POH). We aim to determine risk factors, including whether the presence of bone spicules that influence POH after retrosigmoid VS resection. Design Present study is a retrospective case series. Setting The study was conducted at a tertiary skull-base referral center. Participants Adult patients undergoing VS resection via a retrosigmoid approach between November 2017 and February 2020 were included for this study. Main Outcome Measures Development of POH lasting ≥ 3 months is the primary outcome of this study. Results Of 64 patients undergoing surgery, 49 had complete data (mean age, 49 years; 53% female). Mean follow-up time was 2.4 years. At latest follow up, 16 (33%) had no headaches, 14 (29%) experienced headaches lasting <3 months, 19 (39%) reported POH lasting ≥3 months. Twenty-seven (55%) patients had posterior fossa bone spicules detectable on postoperative computed tomography (CT). Age, gender, body mass index, length of stay, tumor diameter, size of craniectomy, the presence of bone spicules, or the amount of posterior petrous temporal bone removed from drilling did not differ significantly between patients with POH and those without. On multivariate logistic regression, patients with POH were less likely to have preoperative brainstem compression by the tumor (odds ratio [OR] = 0.21, p = 0.028) and more likely to have higher opioid requirements during hospitalization (OR = 1.023, p = 0.045). Conclusion The presence of bone spicules in the posterior fossa on postoperative CT did not contribute to headaches following retrosigmoid craniectomy approach for VS resection.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Risk_factors_studies Language: En Journal: J Neurol Surg B Skull Base Year: 2022 Document type: Article Affiliation country: United States Country of publication: Germany

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Risk_factors_studies Language: En Journal: J Neurol Surg B Skull Base Year: 2022 Document type: Article Affiliation country: United States Country of publication: Germany