Reducing the incidence of persistent headache attributed to retrosigmoid craniotomy: the role of 3D computed tomography venography image-guided technique and bone defects minimization.

OBJECTIVE: The objective of this paper was to assess the risk factors for persistent headache attributed to retrosigmoid craniotomy. Furthermore, we evaluated the role of the 3D computed tomography venography(CTV) image-guided technique in reducing the incidence of persistent headache.

METHOD: The study encompassed patients with trigeminal neuralgia who underwent microvascular decompression. Patients were categorized into two groups based on the use of 3D CTV in surgical planning. Factors related to craniotomy and postoperative complications were analyzed between the two groups. Binary logistic regression analysis was conducted to identify risk factors for persistent headache attributed to craniotomy.

RESULT: The inclusion criteria yielded 48 patients who underwent craniotomy with 3D CTV image guidance (the image-guided group) and 69 patients who did not use this technique (the control group). The image-guided group experienced significantly shorter craniotomy durations (27.9 ± 4.7 vs. 37.5 ± 8.0 min; p  < 0.001), smaller craniotomy areas (472.7 ± 56.7 vs. 617.4 ± 89.7 mm2 ; p  < 0.001), and reduced bone defects (141.8 ± 33.5 vs. 233.2 ± 71.1 mm2 ; p  < 0.001). Bone defect (OR: 1.012; 95% CI: 1.005-1.018; p  < 0.001) was found to be significantly associated with persistent headache in the multivariate analysis.

CONCLUSIONS: Bone defects constitute an independent risk factor for persistent headache attributed to retrosigmoid craniotomy. The 3D CTV image-guided technique effectively reduces the size of bone defects, thereby leading to a reduced incidence of persistent headache postoperatively.