Headache after acoustic neuroma excision

The retrosigmoid approach to acoustic neuroma removal has recently been criticized for causing frequent and severe headache postoperatively. We review 331 patients who had acoustic neuroma removal by the retrosigmoid approach at one institution. The incidence of postoperative headache was 23 percent at 3 months, 16 percent at 1 year, and 9 percent at 2 years. Management was primarily with analgesics, physiotherapy, and reassurance. No patient had additional surgical treatment. Information available indicates that the incidence of postoperative headache associated with the translabyrinthine approach is similar to that of the retrosigmoid approach. Perhaps filling the craniectomy defect will decrease further the incidence of headache postoperatively.