Soumekh B, Levine S C, Haines S J, Wulf J A
Department of Otolaryngology, University of Minnesota, Minneapolis 55455, USA.
Am J Otol. 1996 Jul;17(4):617-9.
The suboccipital approach used for cerebellopontine angle tumors, microvascular decompression, vestibular nerve section, and other procedures has been associated with significant postoperative headache. This study was undertaken to evaluate retrospectively the incidence and management of headaches in these patients.
Operation logs from 1988 through 1993 were reviewed to identify patients who underwent lateral suboccipital craniotomy or craniectomy. The nature of the operation, preoperative and postoperative complaints of headache, treatment for postoperative headache, and the use of primary cranioplasty were recorded from the medical records.
Fifty-six suboccipital approaches were performed by the senior authors between 1988 and 1990. Seven patients had debilitating postoperative headaches. None responded to conservative management, and all underwent secondary cranioplasty. All seven patients showed significant improvement in their pain, with four of seven requiring no other treatment (follow-up from 15 to 38 months). Fifty patients underwent cranioplasty at the time of their initial operation, from 1991 to 1993. No case of debilitating headache was identified post-operatively in these patients.
Cranioplasty at the time of lateral craniectomy appears to reduce the incidence of debilitating postoperative headache.
用于桥小脑角肿瘤、微血管减压、前庭神经切断术及其他手术的枕下入路与术后严重头痛有关。本研究旨在回顾性评估这些患者头痛的发生率及处理情况。
回顾1988年至1993年的手术记录，以确定接受枕下外侧开颅术或颅骨切除术的患者。从病历中记录手术性质、术前和术后头痛主诉、术后头痛的治疗方法以及初次颅骨成形术的使用情况。
1988年至1990年间，资深作者共进行了56次枕下入路手术。7例患者术后出现严重头痛。保守治疗均无效，所有患者均接受了二次颅骨成形术。所有7例患者的疼痛均有显著改善，7例中有4例无需其他治疗（随访15至38个月）。1991年至1993年，50例患者在初次手术时进行了颅骨成形术。这些患者术后未发现严重头痛病例。
外侧颅骨切除时进行颅骨成形术似乎可降低术后严重头痛的发生率。
