Larry and Wind 6,
Have you seen the latest (September 2005) issue of ANA Notes? The Q & A session at the National Symposium in Florida last June featured questions from the audience fielded by doctors William Friedman (Gainesville, FL), moderator, and Patrick Antonelli (Gainesville, FL), Derald Brackmann(House, Los Angeles, CA), and Stephen Lewis (Gainesville, FL), panelists. To the questions why does retrosigmoid surgery cause headaches and what can be done to alleviate these debilitating headaches, Dr. Lewis acknowledged that "they're obviously a very difficult, troublesome and significantly life affecting problem. It depends on the characteristics of the headaches. They can range from simple wound pain, a disruption of the nerve-the cutaneous nerves in the skin-all the way to disruption through fibrous scarring deeper in." He goes on to say that with the retrosigmoid approach "there could have been involvement or division of a nerve called the great occipital nerve, which comes up through the muscles of the neck and supplies the area of the scalp, starts occipitally and radiates forward and gives rise to a characteristic kind of headache and can be exacerbated by palpation of the region. If you push on it, you can really get a bad, bad headache. That can happen with this local scar tissue, if that nerve is working its way to the surface, or may have a neuroma formation itself. There are may ways to treat that, from local medication, anti-inflammatory medications to local injections to steroids and local anesthesia agents to more permanent methods, such as nerve sectioning, freezing, or surgical division of the nerve. It really depends on the exact characteristic of your headache."
Dr. Friedman offers another physiological explanation for the pain and suggests a surgical solution:
"Headaches may be more common after retrosigmoid approach [sic] than after translab. I think the reason is that if you don't reconstruct the area by putting the bone flap back and putting some plastic over the hole, then the dura, the lining of the brain, is in immediate contact not with the skull but overlying muscle. As that scars down, whenever those muscles contract, like whenever you move your head or neck, and the muscle contracts, it pulls on the dura, a pain sensitive structure and that can cause a severe headache. When we do have medically intractable headaches after a retrosigmoid, I encourage patients to think about having a very minor procedure. We open that wound, remove the scar tissue and put a small plastic plate in the bony defect, so that the dura is no longer in contact with the muscle."
Does anyone have any experience with any of the explanations and suggestions for treatment of post-op headaches given by Friedman and Lewis at the AN Symposium?
thanks in advance,
Peanut
