Association between adipose graft usage and postoperative headache after retrosigmoid craniotomy

Abstract

Objective: To evaluate the association between extradural abdominal fat graft placement for the closure of retrosigmoid craniotomy defects and postoperative headache.

Study design: Retrospective chart review and analysis of patient questionnaires.

Setting: Tertiary care academic medical center.

Patients: One hundred twenty-seven patients who underwent retrosigmoid craniotomy between March 1999 and December 2006.

Intervention(s): All patients underwent retrosigmoid craniotomy for removal of cerebellopontine angle tumors and received either an abdominal fat graft closure or a standard wound closure.

Main outcome measure(s): Using a written patient questionnaire, the presence or absence of both overall postoperative headache and specific postcraniotomy headache according to International Headache Society criteria was assessed. Of those patients who had postoperative headaches, the evaluation of headache severity was assessed using a standardized 5-point scale.

Results: Eighty-five patients returned completed questionnaires. Fifty-two respondents received adipose grafts; 33 did not. The adipose group demonstrated significantly less chronic postcraniotomy headaches (11.9% versus 30.3%; p < 0.05). Additionally, the adipose group described less severe headaches at all time frames studied with significant differences at 1 month (1.59 versus 2.29; p < 0.05) and 3 months (1.37 versus 2.06; p < 0.05) using the modified headache severity scale.

Conclusion: When compared with standard wound closure without adipose grafting, use of an abdominal fat graft during retrosigmoid craniotomy wound closure is associated with both decreased incidence of chronic postoperative headache and decreased severity of postoperative headaches at all time intervals studied.