Preservation of the greater occipital nerve during suboccipital craniectomy results in a paradoxical increase in postoperative headaches

Tomas Garzon-Muvdi, Christopher Jackson, Alfred P. See, Graeme F. Woodworth, Rafael J Tamargo

Research output: Contribution to journalArticle

Abstract

Background: Injury to the greater occipital nerve (GON) during suboccipital/retrosigmoid craniectomy (SOC) has been postulated as an etiology of postoperative headaches (HAs). We hypothesized that severe postoperative HAs may be due to the division of the GON during dissection. Objective: To determine whether the GON plays an important role in the development of postoperative HAs. Methods: A retrospective review of prospectively accrued patients undergoing SOC by 1 neurosurgeon at Johns Hopkins from 1995 to 2009 was performed. A total of 280 patients were included in the study. HA was categorized into 3 groups according to the severity and impact on daily activities. Data were analyzed using a stepwise multivariate logistic regression analysis to identify independent factors associated with HA development. Patients with a history of preoperative HAs and migraine were excluded from the analysis. Results: In this cohort, new postoperative severe HAs at last follow-up visit were found in 19% of patients. By multivariate analysis, only GON preservation (relative risk: 1.49; 95% confidence interval: 1.00-2.34; P 0.05) and wound infection (relative risk: 2.29; 95% confidence interval: 0.91-4.25; P 0.07) were statistically significant. By univariate analysis, positive dependent associations included GON preservation (P

Original languageEnglish (US)
Pages (from-to)435-440
Number of pages6
JournalNeurosurgery
Volume76
Issue number4
DOIs
Publication statusPublished - Apr 19 2015

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Keywords

  • Acoustic neuroma
  • Craniectomy pain
  • Greater occipital nerve
  • Postoperative pain
  • Suboccipital craniectomy
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

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