Abstract
Objective: Skull base surgery may cause traction, thermal injury, or scar encasement of the occipital nerve. This may result in delayed or persistent pain in this region. We will outline our findings and long-term results in patients who underwent decompression of the occipital nerve following various approaches to skull base tumors.
Method: A retrospective review of 10 patients was performed. 6 of these patients underwent occipital nerve decompression while the remaining 4 were treated with local anesthetic injections. Primary outcomes were subjective relief of pain. The electronic health records, operative reports, and medications were reviewed from July 2000 to February 2012.
Results: Ten patients were reviewed. Six of these patients underwent surgical occipital nerve decompression. Following surgery, 3 of these patients had complete pain relief, 1 with marked improvement, 1 with slight improvement and 1 with only 4 days of pain resolution. All 6 patients had some degree of scar encasement during exploration. Of the 4 patients undergoing local injections, one patient had multiple injections while the remaining 3 only had 1 injection. This relief lasted a maximum of 1 month. The patient requiring multiple injections also went on to undergo radiofrequency ablation of the nerve with 50% pain relief.
Conclusion: Skull base surgery carries a risk of occipital headaches due to potential nerve injury or adjacent scarring. There are options for the treatment of these pains but the majority are temporary. A surgical option of occipital nerve decompression should be presented to those looking for a more permanent option.
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