Artikel
The impact of surgical approach on acute postcraniotomy headache – a prospective consecutive case series
Die Bedeutung des chirurgischen Zuganges für den akuten Postkraniotomiekopfschmerz – eine prospektive konsekutive Fallserie
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Autoren
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Torge Huckhagel
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Regine Klinger
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Anästhesiologie, Hamburg, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: The latest version of the International Classification of Headache Disorders delineates diagnostic criteria for acute headache attributed to craniotomy, but data on possible predisposing factors are scarce. This study aims to evaluate the impact of the surgical approach on the severity of acute postcraniotomy headache.
Methods: 64 consecutive adults (mean age 54.2±15.2 years; 26 male) undergoing cranial neurosurgery for various reasons without preoperative acute or chronic headache were included. After regaining consciousness, all patients were surveyed about their average daily headache on a numeric pain rating scale (NRS 0-10; 0=no headache; 10=maximum headache) as well as analgesic consumption from day 1 to 3 after surgery. Three distinct patient cohorts were built with respect to the surgical approach (temporal/nuchal muscle saving (n=20) and muscle transecting craniotomies (n=36) as well as burr hole procedures (n=8)) and group comparisons performed using the Kruskal-Wallis test (level of significance p<0.05). Results are presented as mean values± standard deviation.
Results: There were no significant group differences with regard to age, gender or general health condition (American Society of Anesthesiologists Physical Status). Craniotomy patients with muscle transection suffered from significantly higher postoperative NRS scores compared to their counterparts without procedure-related muscle injury (3.4±2.3 versus 2.3±1.9) as well as patients undergoing burr hole surgery (1.2±1.4; p=0.02). Moreover, the consumption of non-opioid analgesics was almost doubled following muscle transecting surgery as compared to muscle preserving procedures (p=0.03). Only one patient received opioids during the postoperative period.
Conclusion: Iatrogenic muscle damage may be an important predisposing factor for the development of acute postcraniotomy headache. Therefore, if a transmuscular approach is unavoidable, the neurosurgeon should be aware of the need for adequately-adjusted, postoperative analgesia in these cases.
