A retrospective review of 53 consecutive patients who underwent a retrosigmoid vestibular
nerve section (VNS) or microvascular decompression (MVD) through a modified suboccipital
craniectomy with a minimum follow-up of 2 years was performed. Technical modifications
to the suboccipital craniectomy included a skin incision designed to avoid the lesser
and greater occipital nerves; a small, 2-cm diameter craniectomy with no intradural
drilling of bone; and a simplified closure to prevent muscle adhesion to dura without
the need for cranioplasty. The presence, duration, and severity of postoperative headache
were the primary outcome measures. Craniectomy-related complications, operative time,
and length of hospital stay were also reviewed. The incidence of postoperative headache
after suboccipital craniectomy was 7.5% at 3 months (4/53), 3.8% at 1 year (2/53),
and 3.8% at 2 years (2/53). Complications related to craniectomy included cerebrospinal
fluid leakage (5.7%), aseptic meningitis (1.9%), and superficial wound infection (1.9%).
The mean operative time was 145 and 98 minutes for VNS and MVD, respectively. The
mean hospital stay was 2.2 and 3.6 days for VNS and MVD, respectively. Technical modifications
of suboccipital craniectomy during retrosigmoid VNS and MVD lowered the incidence
of postoperative headache and craniectomy-related complications and had no adverse
effect on operative time or length of hospital stay.
KEYWORDS
Suboccipital craniectomy - vestibular nerve - microvascular decompression - headache
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Joung H LeeM.D.
Department of Neurological Surgery, The Cleveland Clinic Foundation
S-80, 9500 Euclid Ave.
Cleveland, OH 44195
Email: leej@ccf.org
