Symptom-Based Opioid-Free Treatment for Persistent Postoperative Headache After Vestibular Schwannoma Resection via the Retrosigmoid Approach
Symptom-Based Opioid-Free Treatment for Persistent Postoperative Headache After Vestibular Schwannoma Resection via the Retrosigmoid Approach
复制标题
基于症状的无阿片类药物治疗经乙状结肠后入路治疗前庭神经鞘瘤切除术后持续性头痛
DOI：
10.1016/j.wneu.2022.03.015
复制
发表时间：
2022
影响因子：
2
通讯作者：
Kohmura Eiji
中科院分区：
文献类型：
--
作者：
Fujita Yuichi;Uozumi Yoichi;Yamaguchi Yoji;Nakai Tomoaki;Sasayama Takashi;Kohmura Eiji
目的术后头痛（POH）是前庭神经鞘瘤（VS）切除术后令人不安的症状。然而，目前尚无治疗指南。本研究的目的是评估基于症状的无阿片类药物治疗对 VS 切除术后持续性 POH 的有效性。方法 在 137 例经乙状结肠后入路切除散发性 VS 的患者中，74 例术后 3 个月以上持续性 POH。他们的症状被分类为紧张型头痛、偏头痛、神经痛或其他并接受治疗。我们回顾性分析了术后2年的治疗结果。结果与无POH的患者相比，持续性POH患者明显更年轻（P=0.003），肿瘤明显更小（P=0.001），切除范围更大（P=0.04）。最常见的单纯症状是紧张型头痛（56 例），其次是偏头痛（6 例）和神经痛（5 例）。 7名症状复杂的患者全部都是紧张型头痛和偏头痛的混合体。 40 名患者 (54%) 的 POH 完全消失，51 名患者 (69%) 达到无需药物治疗的状态。没有患者出现无法通过药物控制的残留严重 POH。在面神经功能保留的患者 (P= 0.008) 和症状简单的患者 (P< 0.001) 中，实现包括持续性 POH 完全消失在内的无药物治疗结果的情况更为常见。结论 基于症状的方法适合理解和管理 VS 切除术后持续性 POH，并且具有良好的疼痛控制效果。保留的面神经功能和简单的症状是无药物治疗结果的重要预后因素。
ObjectivePostoperative headache (POH) is a disturbing symptom following vestibular schwannoma (VS) resection. However, there are currently no treatment guidelines. The aim of this study was to evaluate the usefulness of symptom-based opioid-free treatments for persistent POH following VS resection.MethodsOf 137 patients in whom sporadic VS was resected via the retrosigmoid approach, 74 had persistent POH beyond 3 postoperative months. Their symptoms were classified as tension-type headache, migraine, neuralgia, or other and were treated. We retrospectively analyzed the treatment outcomes during 2 postoperative years.ResultsPatients with persistent POH were significantly younger (P= 0.003) and had significantly smaller tumors (P= 0.001) and greater extent of resection (P= 0.04) than patients without POH. The most common simple symptom was tension-type headache in 56 patients, followed by migraine in 6 patients and neuralgia in 5 patients. All 7 patients with complex symptoms had a mixture of tension-type headache and migraine. Complete disappearance of POH was achieved in 40 (54%) patients, and a medication-free condition was achieved in 51 (69%). No patients had residual severe POH that could not be controlled with medication. Achievement of a medication-free outcome that included complete disappearance of persistent POH was significantly more common in patients with preserved facial nerve function (P= 0.008) and patients with simple symptoms (P< 0.001).ConclusionsA symptom-based approach is appropriate for understanding and managing persistent POH after VS resection with excellent pain control. Preserved facial nerve function and simple symptoms are significant prognostic factors for a medication-free outcome.