Headache after Removal of Vestibular Schwannoma Via the Retrosigmoid Approach: A Long‐Term Follow‐Up‐Study

Schaller, Bernhard; Baumann, Andreas

doi:10.1067/mhn.2003.104

Cited by 130 publications

(136 citation statements)

References 26 publications

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“…To date, most studies have focused on pain following microsurgical resection and, in particular, retrosigmoid craniotomy. 1,8,9,14,15,17,21,24,28,33,[36][37][38] This narrow focus has potentially left several significant knowledge gaps. The current study examined headache outcomes among 538 patients with sporadic < 3-cm VS who were managed with microsurgery, SRS, and observation, using a validated headache disability inventory.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Carlson¹,

Tveiten

Driscoll³

et al. 2015

JNS

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O ver the last 100 years, the treatment of vestibular schwannoma (VS) has undergone tremendous evolution. 32 With the increasing use of less invasive management methods including observation, stereotactic radiosurgery (SRS), or radiotherapy and subtotal or neartotal resection, incidences of disease-associated mortality, stroke, and permanent facial neuropathy have been substantially reduced. 12,27,32,41 obJect The primary goals of this study were: 1) to examine the influence of disease and treatment on headache in patients with sporadic vestibular schwannoma (VS); and 2) to identify clinical predictors of long-term headache disability.methods This was a cross-sectional observational study with international multicenter enrollment. Patients included those with primary sporadic < 3-cm VS and a separate group of general population control subjects without tumors. Interventions included a postal survey incorporating the Headache Disability Inventory (HDI), the Hospital Anxiety and Depression Scale, and a VS symptom questionnaire. The main outcome measures were univariate and multivariable associations with HDI total score. results The overall survey response rate was 79%. Data from 538 patients with VS were analyzed. The mean age at time of survey was 64 years, 56% of patients were female, and the average duration between treatment and survey was 7.7 years. Twenty-seven percent of patients received microsurgery, 46% stereotactic radiosurgery, and 28% observation. Patients with VS who were managed with observation were more than twice as likely to have severe headache disability compared with 103 control subjects without VS. When accounting for baseline differences, there was no statistically significant difference in HDI outcome between treatment modalities at time of survey. Similarly, among the microsurgery cohort, the long-term risk of severe headache disability was not different between surgical approaches. Multivariable regression demonstrated that younger age, greater anxiety and depression, and a preexisting diagnosis of headache were the primary predictors of severe long-term headache disability, while tumor size and treatment modality had little influence. coNclusioNs At a mean of almost 8 years following treatment, approximately half of patients with VS experience headaches of varying frequency and severity. Patient-driven factors including age, sex, mental health, and preexisting headache syndrome are the strongest predictors of long-term severe headache disability. Tumor size and treatment modality have less impact. These data may assist with patient counseling regarding long-term expectations following diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Carlson¹,

Tveiten

Driscoll³

et al. 2015

JNS

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“…83 Cranioplasty to seal the bony defect can significantly reduce the incidence of postoperative headaches. 31,82,83 Ruckenstein et al 71 pointed out that although cranioplasty reduces the incidence of headache in the long term, it does not significantly reduce the incidence of headache (compared with the incidence associated with the translabyrinthine approach) in the immediate postoperative period (within 1 year of surgery). Our analysis confirms a significantly higher rate of postoperative headache among patients treated with a retrosigmoid approach as compared with those treated with a translabyrinthine approach.…”

Section: Postoperative Headachesmentioning

confidence: 99%

“…Among these are chemical irritation from the bone dust created by drilling the IAC 11,82 and fibrous adhesions formed between the dura mater and suboccipital muscles. 83 Cranioplasty to seal the bony defect can significantly reduce the incidence of postoperative headaches.…”

Section: Postoperative Headachesmentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

250

216

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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“…No existe acuerdo sobre la escala a utilizar para medir la cefalea o el dolor postoperatorio en el SV [130][131][132] .…”

Section: Dolor Postoperatorio (Cuestionario Específico Y Quejas Sobreunclassified

“…Schaller y Baumann 132 hallaron que los pacientes con dolor postoperatorio tenían tumores más pequeños.…”

Section: Dolor Postoperatorio (Cuestionario Específico Y Quejas Sobreunclassified

Calidad de vida tras la cirugía del schwannoma vestibular

Alfonso

Lassaletta

Sarriá

et al. 2007

Acta Otorrinolaringológica Española

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Headache after Removal of Vestibular Schwannoma Via the Retrosigmoid Approach: A Long‐Term Follow‐Up‐Study

Cited by 130 publications

References 26 publications

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Surgery for vestibular schwannomas: a systematic review of complications by approach

Calidad de vida tras la cirugía del schwannoma vestibular

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