Role of Craniotomy Repair in Reducing Postoperative Headaches After a Retrosigmoid Approach

BACKGROUND: The retrosigmoid (RS) approach provides an excellent access corridor to the cerebellopontine angle. However, 80% of patients experience headaches after RS approaches. OBJECTIVE: We reviewed our prospective database to determine the risk factors influencing headaches after RS procedures. METHODS: From 2003, craniotomy, instead of craniectomy, became our standard approach for RS procedures. Patients' demographic, management, and outcome data were collected prospectively. We also retrospectively analyzed similar data collected between 2000 and 2003 to compare headache outcomes after RS approaches. Subgroup analysis of data was performed to identify other risk factors contributing to postoperative headaches. RESULTS: Of 105 patients (mean age, 56 years; 43 men; 62 women) who underwent RS surgery, 30 underwent craniectomy and 75 underwent craniotomy. There were 57 vestibular schwannomas, 40 microvascular decompressions, and 8 other procedures. The patients' age, sex, pathological diagnosis, and length of hospital stay were not statistically different in the 2 subgroups. At discharge, postoperative headache was observed in 43% of patients (13/30) after craniectomy and 19% of patients (14/75) after craniotomy (P = .01). The incidence of headache decreased with further follow-up; 10% of patients (3/30) who underwent craniectomy and 1% of patients (1/75) who underwent craniotomy still had headache at 12 months of follow-up. CONCLUSION: Patients who underwent the RS approach with craniotomy had a significantly lower rate of headache at discharge than did those who underwent craniectomy. These patients continued to have a lower incidence of headache in the long term.