Retrosigmoid Approach and Post Operative Headaches

[Syl]

Hi Sylvia,   I am interested to find out what the neurosurgeon is doing to help you.   All mine told me to do is to take Motrin and after two weeks the headaches would go away.

Did I say neurosurgeon? I meant neurologist. He started me off with Pamelor, which helpe get me off my Tylenol dependence. I took Pamelor for just under 1 year. After noticing that there wasn't more improvement for some months, I opted out. I didn't want to take any other meds so he recommended icing my neck every morning & also every night before bed. I've been doing that and have noticed more improvement. For now I'm sticking to icing my neck.

Syl

[Mei Mei]

Dear Sylvia,
I've been using a hydoculator neck pad all weekend.   It's relaxing but the pain in the neck doesn't go away and I still have a headache.   I went to PubMed at the advice of a man in our Local DC ANA group meeting on Saturday and found three articles on headaches with AN.   Here they are:

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This message contains search results from the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM). Do not reply directly to this message

Sent on: Sat May 15 19:17:48 2010
1 selected item: 12646842



PubMed Results
Item 1 of 1

1.   Otolaryngol Head Neck Surg. 2003 Mar;128(3):387-95.
Headache after removal of vestibular schwannoma via the retrosigmoid approach: a long-term follow-up-study.

Schaller B, Baumann A.
Max-Planck-Institute for Neurological Research, Cologne, Germany. Bernahard.Schaller@pet.mpin-koeln.mpg.de

Abstract

OBJECTIVE: Our goal was to study the occurrence and source of origin of postcraniotomy headache syndrome after removal of vestibular schwannoma via the retrosigmoid approach. METHODS: A retrospective chart analysis was conducted of all patients with headache at 3 months after removal of vestibular schwannoma from January 1981 through March 1997 and with a minimum of 24 months of follow-up. Diagnosis was made according to the headache classification and was graded using the HARNER scale. Recovery outcome was compared in selected groups of patients with and without headache. A descriptive statistical analysis was used to analyze differences between groups. RESULTS: Of the patients who underwent retrosigmoid craniotomy for removal of vestibular schwannomas, 52 of 155 patients (34%) reported having severe headache of requiring medication every day and/or feeling incapacitated 3 months after surgery. Headache was more prevalent in those who had the bone flap replaced (94% versus 27%), if there was duraplastic or direct dura closure (0% versus 100%). Laboratory-proven aseptic meningitis, most likely due to the use of fibrin glue and drilling of posterior aspect of the internal auditory canal, was mainly associated with postoperative headache (81% versus 2%). In 75% of these cases, calcifications along the brainstem had been noted. CONCLUSION: The origin of postoperative headaches after retrosigmoid vestibular schwannoma resections is not yet fully understood. Different factors may play a role in preventing or reducing headache: dural adhesions to nuchal muscles or to subcutaneous tissues and dural tension in the case of direct dural closure may explain postoperative headache from dural tension. Intradural drilling and the use of fibrin glue may be the source of aseptic meningitis as the etiology of persistent postoperative headache. Prevention of postoperative headache may include the replacement of bone flap at the end of surgery, duraplastic instead of direct dural closure, and prevention of the use of fibrin glue or extensive drilling of the posterior aspect of internal auditory canal.

PMID: 12646842 [PubMed - indexed for MEDLINE]
 

MeSH Terms:

Adolescent
Adult
Aged
Craniotomy/methods
Female
Fibrin Tissue Adhesive/adverse effects
Fibrin Tissue Adhesive/therapeutic use
Follow-Up Studies
Headache/etiology*
Humans
Male
Meningitis, Aseptic/etiology
Middle Aged
Neuroma, Acoustic/surgery*
Postoperative Complications/etiology*
Postoperative Complications/prevention & control
Tissue Adhesives/adverse effects
Tissue Adhesives/therapeutic use
Substances:

Fibrin Tissue Adhesive
Tissue Adhesives

[Mei Mei]

Dear Sylvia:   Here's another from Pub Med on Prevention and Bone Dust:

This message contains search results from the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM). Do not reply directly to this message

Sent on: Sat May 15 19:11:11 2010
Search: acoustic neuroma Post surgical headaches retrosigmoid



PubMed Results
Item 1 of 1

1.   Am J Otol. 1996 Nov;17(6):904-8.
Prevention of headache after retrosigmoid removal of acoustic tumors.

Catalano PJ, Jacobowitz O, Post KD.
Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York, USA.

Abstract

OBJECTIVE: To demonstrate a causal relationship between bone dust and the development of headache after retrosigmoid removal of acoustic neuromas. STUDY DESIGN: The study design was both retrospective (group I) and prospective (groups 2 and 3). SETTING: Tertiary Care Referral Center/Outpatient Data Collection. PATIENTS: Eighty-four consecutive patients underwent surgery at the Mount Sinai Medical Center in New York by the same surgical team. INTERVENTION: All patients underwent retrosigmoid removal of acoustic neuromas via the following methods: group 1, standard excision; group 2, excision and cranioplasty; group 3, excision, cranioplasty, and residue trapping. MAIN OUTCOME MEASURE: Presence or absence of postoperative headache. RESULTS: In all, 43 patients (51%) reported postoperative headache. By groups, headache incidence was 64% for group 1 (43% grade 3-4), 81% for group 2 (37% grade 3-4), and 10% (all grade 1) for group 3. Differences with respect to headache incidence and severity were statically significant between groups 1 and 3, and between groups 2 and 3 (p < 0.001). CONCLUSIONS: Free circulation of bone dust into the posterior fossa during intradural drilling of the internal auditory canal may be the most important factor in the development of headache after this surgical procedure.

PMID: 8915420 [PubMed - indexed for MEDLINE]
Publication Types:

Comparative Study
MeSH Terms:

Adolescent
Adult
Aged
Ear Neoplasms/pathology
Ear Neoplasms/surgery*
Female
Headache/etiology*
Headache/prevention & control*
Humans
Male
Middle Aged
Neuroma, Acoustic/pathology
Neuroma, Acoustic/surgery*
Postoperative Complications*
Severity of Illness Index
Tomography, X-Ray Computed
Treatment Outcome
Vestibulocochlear Nerve/pathology
Vestibulocochlear Nerve/surgery*

[Mei Mei]

Here's another article on Bone Dust I found on Pub Med and the National Library of Medicine:

http://synapse.koreamed.org/Synapse/Data/PDFData/0032JKNS/jkns-47-158.pdf

I will bring these articles with me to my neurologist visit.   Hopefully he will point me in the right direction.   I want to find out if I have bone dust or what the problem is that is causing the head aches.

Mei Mei

[jennifer7]

Hi Mei Mei
I have not had a headache last more than 10 minutes or very painful since Friday night so I am starting to think (hope, pray) the chiropractor may be helping.  I still hold my head crooked and my neck muscles are tight but no REAL headaches.  I also started massage for my neck and face--I have facial weakness.  I'll let you know if they continue improving.
Jennifer

[Mei Mei]

That's great, I'm happy for you!   Several days and counting.   I'm getting a neck and occipital area massage tomorrow at the PT.   It was so gentle that it didn't help much.   I was more aggressive last night on it and stimulated it too much bringing on a bad headache in the middle of the night.   I have a small one right now.   I'm looking for a neurologist that knows something about this post surgical headache stuff around DC. 

Keep up those visits to the chiropractor and I'll wait to hear from you

Take care,
Mei Mei

[mare4ever1]

MEI MEI,

I SUFFER FROM HEADACHES AS WELL. I HAD TRANS LAB SURGERY DONE ALMOST 2 YEARS AGO. FUNNY THING WAS I DIDN'T HAVE HEADACHES RIGHT AWAY. LAST SUMMER IS WHEN I STARTED GETTING THEM. AND WHEN I DON'T HAVE A HEADACHE MY HEAD ON THE RIGHT SIDE WHERE THE SURGERY WAS DONE, IS IN CONSTANT PAIN. I'M KEEPING THE PAIN MEDS COMPANY IS BUSINESS . I WAS TOLD THAT THERE IS NOTHING THAT CAN BE DONE. I'M IN THE 1% CATERGORY OF PATIENTS WHO WILL SUFFER WITH HEADACHES FROM NOW ON. SO, FOR ME, SADLY , IT'S A WAY OF LIFE THAT I'VE GOTTEN USED TO. TAKE CARE. MARE

[Lizard]

Mare,

There are so many Dr's with many tools to use, you shouldn't just give up on the headaches.  There can be help out there for you.  It makes me so sad to see you just accept that this is the way it has to be.  In my opinion it doesn't.  What kind of Dr's have you seen? Meds?  Therapies?
Now I'm sad for you as I also have headaches and have not given up and now the Dr's have found the cause of one type now we need to work on the others. 

Hang in there and don't take this as your final diagnosis!
Liz

[Mei Mei]

Yes, I agree with Liz, Mare.   Don't give up and take this lying down.   There has to be a solution.  Go to a headache specialist and bring the March issue of the newsletter with you on Postsurgical Headaches with you.   Insist that you have a post surgical headache and not a migraine.    I went today for a neck and what the therapist called a sub occipital massage.  I feel much better.   She told me to come home and put a hot hydroculator pad on it so that's what I am doing.  It's loosened up quite a bit after two treatments.

Please don't give up.   Where do you live?   I will help you find a doctor in your area.

Mei Mei

[Syl]

Mare:

Who told you nothing could be done about your headaches? Besides the meds, what have you tried for the pain? What meds do you take and how often. Have you tried applying heat or icing your neck? If you take some pain meds too often, your body becomes dependent on them resulting in a vicious cycle that gives you more headaches. What works for some may not work for others, but we have to try and find a solution for these headaches.

Syl

[leapyrtwins]

Mare:

Who told you nothing could be done about your headaches?

Good point.  Captain Deb is one who has suffered from headaches - some doozies - and she's found ways to get relief.  You should search for her posts.

Jan

[Captain Deb]

Hi Mare,
Please do not accept that you will have these headaches forever--there is a lot that can be done besides living on pain meds, which can do more harm than good.  Don't rely on your neurosurgeon as the last word, find a headache pecialist.  I believe that many of us will never know exactly what is causing our headaches as they stem from multiple sources, but there is a lot we can do to alleviate the symptoms--nerve blocks, Botox, preventive meds, physical therapy.  Don't give up!!

Capt Deb

[Mei Mei]

Yes,  Listen to captain Deb.  She gives good advice   that will help you.  Doon't give up non matter what!!!!!   Mei Mei

[mare4ever1]

THANKS ALL FOR THE ADVICE. MY ENT WHO WAS ON THE TEAM OF SURGEONS WHO PERFORMED MY SURGEY, TOLD ME THERE WAS NOTHING TO BE DONE. I DID TAKE PERCOSET, AFTER SURGERY. I TRIED TAKING THEM AGAIN AND THEY DON'T WORK. SO, I ALTERNATE BETWEEN, TYLENOL. ADVIL. ALEVE AND EXCEDRIN. I HAVEN'T TRIED ICING MY NECK OR PUTTING HEAT ON IT. I DO USE NECK PILLOWS. SOMETIMES THAT'S WHERE THE HEADACHES ORIGANTE FROM. DO I ICE FIRST THEN THE HEAT. I GO BACK NEXT JAN. FOR ANOTHER M.R.I., I HAVE A RESIDUAL TUMOR THEY ARE WATCHING. THANKS FOR THE ENCOURAGEMENT.

[Captain Deb]

Keeping a headache journal can be a very useful tool when you go see a specialist.  Be sure and write down the time of day and location of the headache,  level of pain on a 1-10 scale, length of headache, what you ATE (this can be important) and if there are any weather patterns like low barometric pressure (usually what you get when it rains) and any emotional stressors you are experiencing.  This is an very valuable tool for a headache specialist in designing your treatment plan.  Also do some research on rebound headaches, which you can get from over-use of OTC meds.  It sounds like you are at the point where you need to be on a preventive med like gabapentin (Neurontin).  Injection therapy has worked great for me, too.  Started with nerve blocks and am now getting Botox, which has worked really good for the headaches that move to my temple, eye, and forehead.  Most headache clinics have websites or your doc can refer you to one.

Capt Deb