PAIN SUBSEQUENT TO RESECTION OF ACOUSTIC NEUROMAS VIA SUBOCCIPITAL AND TRANSLABYRINTHINE APPROACHES

Prolonged headache subsequent to excision of acoustic neuromas via a s uboccipital approach has been cited as a significant complication of t his procedure. However, few studies have sought to compare the inciden ce of postoperative headaches in patients undergoing either translabyr inthine or suboccipital approaches with surgical techniques designed t o minimize this complication. We performed a retrospective survey of 5 2 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 numer ic scale at 1 month, 6 months, and 1 year after surgery. Medications r equired to control headaches were also recorded. At 1 and 6 months aft er surgery, headache severity was significantly less in patients havin g undergone a translabyrinthine resection (p < 0.05). However, by 1 ye ar after surgery headache severity in the two groups of patients was e ssentially equivalent (p = 0.6). Data concerning the strength of analg esics required to control postoperative headaches paralleled these res ults. These results indicate that within the first postoperative year, patients undergoing suboccipital craniotomies have significantly more postoperative pain than do those patients having undergone translabyr inthine 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 tho se having undergone translabyrinthine surgery. These results are impor tant to both the surgeon and the patient during preoperative counselin g regarding the choice of surgical approach for acoustic neuroma excis ion.