Cranioplasty in acoustic neuroma surgery

Objectives: To measure the incidence of postoperative headaches after retro sigmoid resections of acoustic neuromas and to evaluate the impact of crani oplasty on the prevention and management of these headaches. Study Design: A prospective evaluation was performed on 30 consecutive patients who under went a cranioplasty after retrosigmoid excision of their acoustic neuroma T he results were compared with 30 historical control patients who underwent the same procedure but did not have reconstruction with a cranioplasty, The patients were evaluated by review of office records and via telephone ques tionnaire. Methods: One group of patients (30 patients) had no cranioplasty , and the other group of 30 patients had primary reconstruction with a tita nium mesh-acrylic cranioplasty, All 60 patients were asked to report on the duration and severity of their headaches by means of a standard questionna ire, grading their symptoms on a scale of 1 to 4. The data were subjected t o chi(2) and Student t test statistical analyses. Results: New-onset, posto perative headaches occurred in 27% of patients, 23% in the cranioplasty gro up compared with 30% in the group without cranioplasty (a difference that w as not statistically significant [P = .158]), However, there was a statisti cally significant difference in the severity of the headaches (P < .03). Th e headaches in the cranioplasty group were less severe and were not disabli ng. There were no complications, infections, or extrusions related to the c ranioplasty. Conclusions: Cranioplasty has not been able to eliminate posto perative headaches. However, the use of cranioplasty has significantly decr eased the severity of postoperative headaches after retrosigmoid excision o f acoustic neuromas.