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J Neurol Surg B Skull Base 2022; 83(04): 374-382
DOI: 10.1055/s-0041-1741112
Original Article

Dispersed Bone Spicules as a Cause of Postoperative Headache after Retrosigmoid Vestibular Schwannoma Surgery: A Myth?

Yin Ren 
1   Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
5   Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States
,
Marin A. McDonald
2   Department of Radiology, University of California San Diego, La Jolla, California, United States
,
Paul Manning
2   Department of Radiology, University of California San Diego, La Jolla, California, United States
,
Bridget V. MacDonald
3   Department of Otolaryngology Head and Neck Surgery, University of California Davis, Sacramento, California, United States
,
Marc S. Schwartz
4   Department of Neurosurgery, University of California San Diego, La Jolla, California, United States
,
Rick A. Friedman
5   Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States
,
Jeffrey P. Harris
5   Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, United States
› Author Affiliations Funding None.
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Abstract

Objectives Dispersion of bone dust in the posterior fossa during retrosigmoid craniectomy for vestibular schwannoma (VS) resection could be a source of meningeal irritation and lead to development of persistent postoperative headaches (POH). We aim to determine risk factors, including whether the presence of bone spicules that influence POH after retrosigmoid VS resection.

Design Present study is a retrospective case series.

Setting The study was conducted at a tertiary skull-base referral center.

Participants Adult patients undergoing VS resection via a retrosigmoid approach between November 2017 and February 2020 were included for this study.

Main Outcome Measures Development of POH lasting ≥ 3 months is the primary outcome of this study.

Results Of 64 patients undergoing surgery, 49 had complete data (mean age, 49 years; 53% female). Mean follow-up time was 2.4 years. At latest follow up, 16 (33%) had no headaches, 14 (29%) experienced headaches lasting <3 months, 19 (39%) reported POH lasting ≥3 months. Twenty-seven (55%) patients had posterior fossa bone spicules detectable on postoperative computed tomography (CT). Age, gender, body mass index, length of stay, tumor diameter, size of craniectomy, the presence of bone spicules, or the amount of posterior petrous temporal bone removed from drilling did not differ significantly between patients with POH and those without. On multivariate logistic regression, patients with POH were less likely to have preoperative brainstem compression by the tumor (odds ratio [OR] = 0.21, p = 0.028) and more likely to have higher opioid requirements during hospitalization (OR = 1.023, p = 0.045).

Conclusion The presence of bone spicules in the posterior fossa on postoperative CT did not contribute to headaches following retrosigmoid craniectomy approach for VS resection.

Keywords

bone spicule - retrosigmoid - suboccipital - acoustic neuroma - vestibular schwannoma - headache

Note

This study was presented as a poster at the 154th American Otological Society Annual Virtual Spring Meeting on April 2021.


Supplementary Material



Publication History

Received: 18 May 2020

Accepted: 05 November 2021

Article published online:
31 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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