Pain subsequent to resection of acoustic neuromas via suboccipital and translabyrinthine approaches

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.