Introduction: While postoperative outcomes of acoustic neuroma (AN) resection most commonly consider hearing preservation and facial function, headache and incisional pain are important quality of life determinants. While postoperative headache is described in the literature, there is a paucity of discussion on postoperative occipital neuralgia following AN resection. We report our experience with this challenging complication to better elucidate effective management.
Methods: We conducted a retrospective review of 875 AN patients who underwent surgical resection at our institution between 1988 and 2017 and found 17 patients who developed occipital neuralgia postoperatively. All patients had undergone resection via a retrosigmoid or translabyrinthine approach via a large retroauricular incision with layered flap elevation. Duration and severity of occipital neuralgia and response to treatment modalities, such as pain medications, occipital nerve blocks and surgical nerve decompression or occipital neurectomy, were recorded. Potential predictors for the development of occipital neuralgia were assessed with binary logistic regression models.
Results: Patients with tumor removal via the restrosigmoid approach were 6.85 times more likely to develop occipital neuralgia postoperatively (OR 6.85, 95% CI: 1.55 – 30.39, p=.01). Although many of our patient's occipital neuralgia was refractory to medication and were only temporarily relieved by occipital nerve blocks, six of our patients responded to these treatments and did not necessitate surgery. Some patients who developed occipital neuralgia had wound healing complications, including infection.
Conclusions: While some of the literature suggest that patients with occipital neuralgia following surgery will not respond to drug treatment, our population suggests a nuanced response to the different treatment modalities. Thus, we suggest a thorough course of medical management and occipital nerve blocks prior to pursuing surgical treatment. Further studies are needed to identify the salient characteristics that define which patients will respond to pain medications and which will need more invasive treatment.
Patient Care: Postoperative headache, and in particular occipital neuralgia, is disruptive to the quality of life of a patient. By developing a systematic treatment algorithm for this postoperative pain syndrome, we can aim to improve a patient’s clinical course in a conservative fashion.
Learning Objectives: •Occipital neuralgia is an uncommon, but disabling and challenging postoperative complication following acoustic neuroma resection.
•The retrosigmoid approach is far more common in those patients who develop occipital neuralgia following surgery, although this makes up less than 4% of patients with a retrosigmoid approach overall.
•Many patients necessitate surgery to improve their pain, but some respond well to drug treatment and occipital nerve blocks and do not need surgery.