Garzon-Muvdi Tomas, Jackson Christopher, See Alfred P, Woodworth Graeme F, Tamargo Rafael J
*Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; ‡Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
Neurosurgery. 2015 Apr;76(4):435-40; discussion 440. doi: 10.1227/NEU.0000000000000625.
Injury to the greater occipital nerve (GON) during suboccipital/retrosigmoid craniectomy (SOC) has been postulated as an etiology of postoperative headaches (HAs). We hypothesized that severe postoperative HAs may be due to the division of the GON during dissection.
To determine whether the GON plays an important role in the development of postoperative HAs.
A retrospective review of prospectively accrued patients undergoing SOC by 1 neurosurgeon at Johns Hopkins from 1995 to 2009 was performed. A total of 280 patients were included in the study. HA was categorized into 3 groups according to the severity and impact on daily activities. Data were analyzed using a stepwise multivariate logistic regression analysis to identify independent factors associated with HA development. Patients with a history of preoperative HAs and migraine were excluded from the analysis.
In this cohort, new postoperative severe HAs at last follow-up visit were found in 19% of patients. By multivariate analysis, only GON preservation (relative risk: 1.49; 95% confidence interval: 1.00-2.34; P = 0.05) and wound infection (relative risk: 2.29; 95% confidence interval: 0.91-4.25; P = 0.07) were statistically significant. By univariate analysis, positive dependent associations included GON preservation (P < .01), reconstruction of the porus with hydroxyapatite cement (P = 0.02), and wound infection (P < 0.01). Statistically significant differences in the incidence of HA after surgery were found in patients in whom the GON was preserved compared with patients in whom the GON was divided (P = 0.035).
Postoperative debilitating HAs are a common complication after SOC. Although these HAs are probably multifactorial in nature, preservation of the GON during SOC is independently associated with postoperative debilitating HAs.
枕下/乙状窦后开颅术（SOC）期间枕大神经（GON）损伤被认为是术后头痛（HA）的病因之一。我们推测术后严重头痛可能是由于解剖过程中GON的离断所致。
确定GON在术后HA发生中是否起重要作用。
对1995年至2009年约翰·霍普金斯医院1名神经外科医生进行的SOC前瞻性累积患者进行回顾性研究。共纳入280例患者。根据严重程度和对日常活动的影响，将HA分为3组。采用逐步多因素逻辑回归分析对数据进行分析，以确定与HA发生相关的独立因素。术前有HA和偏头痛病史的患者被排除在分析之外。
在该队列中，19%的患者在最后一次随访时出现新的术后严重HA。多因素分析显示，只有GON保留（相对风险：1.49；95%置信区间：1.00 - 2.34；P = 0.05）和伤口感染（相对风险：2.29；95%置信区间：0.91 - 4.25；P = 0.07）具有统计学意义。单因素分析显示，正相关因素包括GON保留（P <.01）、用羟基磷灰石水泥重建孔隙（P = 0.02）和伤口感染（P < 0.01）。与GON被离断的患者相比，GON被保留的患者术后HA发生率有统计学显著差异（P = 0.035）。
术后致残性HA是SOC后的常见并发症。虽然这些HA可能本质上是多因素的，但SOC期间GON的保留与术后致残性HA独立相关。
