The American journal of otology
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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. ⋯ 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.
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The suboccipital approach used for cerebellopontine angle tumors, microvascular decompression, vestibular nerve section, and other procedures has been associated with significant postoperative headache. This study was undertaken to evaluate retrospectively the incidence and management of headaches in these patients. ⋯ Cranioplasty at the time of lateral craniectomy appears to reduce the incidence of debilitating postoperative headache.
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Patients with satisfactory facial nerve function [House-Brackmann (HB) grade I or II] immediately after acoustic neuroma surgery are at risk for delayed facial paralysis. To study this problem, 255 consecutive patients who underwent acoustic neuroma excision with facial nerve preservation were identified. Delayed facial paralysis occurred in 62 (24.3%) patients; 90% ultimately recovered to their initial postoperative HB grade, and 98.3% recovered to within one grade of their initial HB level. ⋯ Of patients who demonstrated nerve deterioration to grades IV-VI, 20 of 38 required tarsorrhaphy or gold-weight placement. We conclude that the over-whelming majority of patients with delayed facial paralysis after acoustic neuroma surgery do eventually recover to their postoperative HB grade. The magnitude and timecourse of delayed facial paralysis are predictive factors for subsequent recovery.