Abstract
The lateral suboccipital approach to the cerebellopontine angle is typically performed
as a small craniectomy. Incisional pain and headache following cerebellopontine angle
surgery have been reported. Adherence of the cervical muscles to the dura, which is
richly innervated, with consequent traction has been suggested to be responsible for
postoperative headache. Therefore, postoperative headache probably could be reduced
by replacing the bone flap between the muscles and the dura. In a prospective nonrandomized
study this hypothesis was tested by comparing craniectomy and craniotomy. 40 patients
underwent removal of an acoustic neuroma via the retrosigmoid approach. Patients with
a history of migraine, with additional intracerebral tumors or recurrencies as well
as patients who developed a CSF fistula postoperatively were excluded. 29 patients
were eligible for further evaluation. 13 patients underwent a craniotomy, 16 patients
a craniectomy. All patients were subject to a standardized telephone interview three
months and one year after surgery. Comparing the craniotomy group to the craniectomy
group no difference was observed regarding age, sex, tumor size and duration of operation.
3 months as well as 12 months postoperatively headache was significantly (p<0.05)
less frequent in the craniotomy group as compared to the craniectomy group. In conclusion,
an osteoplastic craniotomy significantly reduces postoperative headache and is therefore
highly recommended.
Key words
Acoustic Neuroma - Retrosigmoid Approach - Headache - Craniotomy
