Riedy Loren N, Heiferman Daniel M, Szujewski Caroline C, Malina Giselle Ek, Rezaii Elhaum G, Martin Brendan, Grahnke Kurt A, Doerrler Michael, Leonetti John P, Anderson Douglas E
Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States.
University of Chicago, Committee on Neurobiology, Chicago, Illinois, United States.
J Neurol Surg B Skull Base. 2021 Feb 22;83(Suppl 2):e135-e142. doi: 10.1055/s-0041-1722934. eCollection 2022 Jun.
While postoperative outcomes of acoustic neuroma (AN) resection commonly consider hearing preservation and facial function, headache is a critical quality of life factor. Postoperative headache is described in the literature; however, there is limited discussion specific to occipital neuralgia (ON) following AN resection. The aim of this study is to investigate the effectiveness of conservative management and surgery. We conducted a retrospective review of 872 AN patients who underwent resection at our institution between 1988 and 2017 and identified 15 patients (1.9%) that met International Classification of Headache Disorders criteria for ON. Of the 15 ON patients, surgical approaches included 13 (87%) retrosigmoid (RS), one (7%) translabyrinthine (TL), and one (7%) combined RS + TL. Mean clinical follow-up was 119 months (11-263). Six (40%) patients obtained pain relief through conservative management, while the remaining nine (60%) underwent surgery or ablative procedure. Three (38%) patients received an external neurolysis, four (50%) received a neurectomy, one (13%) had both procedures, and one (13%) received two C2 to 3 radio frequency ablations. Of the nine patients who underwent procedural ON treatment, seven (78%) patients achieved pain relief, one patient (11%) continued to have pain, and one patient (11%) was lost to follow-up. Of the six patients whose pain was controlled with conservative management and nerve blocks, five (83%) found relief by using neuropathic pain medication and one (17%) found relief on nonsteroidal anti-inflammatory drug. Our series demonstrates success with conservative management in some, but overall a minority (40%) of patients, reserving decompression only for refractory cases.
虽然听神经瘤（AN）切除术后的结果通常考虑听力保留和面部功能，但头痛是影响生活质量的关键因素。文献中描述了术后头痛；然而，关于AN切除术后枕神经痛（ON）的具体讨论有限。 本研究的目的是调查保守治疗和手术的有效性。 我们对1988年至2017年间在我院接受切除术的872例AN患者进行了回顾性研究，确定了15例（1.9%）符合国际头痛疾病分类标准的ON患者。 在15例ON患者中，手术方式包括13例（87%）乙状窦后入路（RS）、1例（7%）迷路后入路（TL）和1例（7%）联合RS+TL。平均临床随访时间为119个月（11 - 263个月）。6例（40%）患者通过保守治疗缓解了疼痛，其余9例（60%）接受了手术或消融治疗。3例（38%）患者接受了外膜松解术，4例（50%）患者接受了神经切除术，1例（13%）患者同时接受了这两种手术，1例（13%）患者接受了两次C2至3射频消融术。在接受手术治疗ON的9例患者中，7例（78%）患者疼痛缓解，1例患者（11%）仍有疼痛，1例患者（11%）失访。在6例通过保守治疗和神经阻滞控制疼痛的患者中，5例（83%）通过使用神经性疼痛药物缓解，1例（17%）通过使用非甾体抗炎药缓解。 我们的系列研究表明，部分患者（但总体上是少数，40%）通过保守治疗取得了成功，仅对难治性病例进行减压手术。
