Ruckenstein M J, Harris J P, Cueva R A, Prioleau G, Alksne J
Department of Otolaryngology, Head and Neck Surgery, University of Tennessee, Memphis 38163, USA.
Am J Otol. 1996 Jul;17(4):620-4.
Prolonged headache subsequent to excision of acoustic neuromas via a suboccipital approach has been cited as a significant complication of this procedure. However, few studies have sought to compare the incidence of postoperative headaches in patients undergoing either translabyrinthine or suboccipital approaches with surgical techniques designed to minimize this complication. We performed a retrospective survey of 52 patients having undergone either a suboccipital or translabyrinthine resection of acoustic neuromas. Cranioplasties were performed on all patients having undergone resections via a suboccipital approach. The survey asked patients to categorize headache severity based on a numeric scale at 1 month, 6 months, and 1 year after surgery. Medications required to control headaches were also recorded. At 1 and 6 months after surgery, headache severity was significantly less in patients having undergone a translabyrinthine resection (p < 0.05). However, by 1 year after surgery, headache severity in the two groups of patients was essentially equivalent (p = 0.6). Data concerning the strength of analgesics required to control postoperative headaches paralleled these results. These results indicate that within the first postoperative year, patients undergoing suboccipital craniotomies have significantly more postoperative pain than do those patients having undergone translabyrinthine resections, despite the performance of a cranioplasty. However, by 1 year after surgery, these differences are no longer significant. Thus the complication of long-term postoperative headache is no more prevalent in patients undergoing a suboccipital resection than in those having undergone translabyrinthine surgery. These results are important to both the surgeon and the patient during preoperative counseling regarding the choice of surgical approach for acoustic neuroma excision.
经枕下入路切除听神经瘤后出现的持续性头痛被认为是该手术的一项重大并发症。然而，很少有研究试图比较采用经迷路入路或枕下入路并运用旨在将这一并发症降至最低的手术技术的患者术后头痛的发生率。我们对52例行枕下或经迷路听神经瘤切除术的患者进行了一项回顾性调查。所有经枕下入路切除的患者均进行了颅骨成形术。该调查要求患者根据术后1个月、6个月和1年的数字评分量表对头痛严重程度进行分类。还记录了控制头痛所需的药物。术后1个月和6个月时，经迷路切除术患者的头痛严重程度明显较轻（p<0.05）。然而，到术后1年时，两组患者的头痛严重程度基本相当（p = 0.6）。关于控制术后头痛所需镇痛药强度的数据与这些结果一致。这些结果表明，在术后第一年，尽管进行了颅骨成形术，但接受枕下开颅手术的患者术后疼痛明显多于接受经迷路切除术的患者。然而，到术后1年时，这些差异不再显著。因此，长期术后头痛这一并发症在接受枕下切除术的患者中并不比接受经迷路手术的患者更普遍。这些结果对于外科医生和患者在术前咨询听神经瘤切除手术入路选择时都很重要。
