16/06/2024
Delayed-onset post-craniotomy headache responsive to botulinum toxin A: a case series - Ranoux, D., Martiné, G., Espagne, G. et al. Acta Neurochir (2017) 159: 1375. https://doi.org/10.1007/s00701-017-3215-z
Lutman, B., Bloom, J., Nussenblatt, B. et al. A Contemporary Perspective on the Management of Post-Craniotomy Headache and Pain. Curr Pain Headache Rep 22, 69 (2018). https://doi.org/10.1007/s11916-018-0722-4
Peri-Incisional Botulinum Toxin for Chronic Postcraniotomy Headache After Traumatic Brain Injury: A Case Series by M.MacKenzieMD RobertTeasell MD, FRCPCb Thomas A.Miller MD, FRCPCc KeithSequeiraMD, FRCPCd in PM&R
Volume 7, Issue 7, July 2015, Pages 785-788
https://doi.org/10.1016/j.pmrj.2015.02.015
Dang, S., Shinn, J.R., Sowder, J., Ries, W.R. and Stephan, S.J. (2019), Peri-Incisional Botulinum Toxin Therapy for Treatment of Intractable Head Pain After Lateral Skull Base Surgery: A Case Series. Headache: The Journal of Head and Face Pain, 59: 1624-1630. https://doi.org/10.1111/head.13616
excerpts-
Abstract
Objective
The objective of this case series was to describe botulinum toxin therapy as a novel treatment of intractable head pain following lateral skull base surgery.
Background
Intractable headaches following lateral skull base surgery are described in 23%-75% of patients and can significantly impact quality of life. Currently, the etiology of the headaches is unclear and treatment options are limited. Botulinum toxin is indicated for a multitude of functional and cosmetic reasons, including chronic migraine, and has been further described in treatment of various postsurgical pain syndromes.
Methods
In this case series, 4 patients underwent subcutaneous peri-incisional injections of botulinum toxin for intractable headache and head pain syndromes. Three patients had undergone lateral skull base surgery and the fourth patient had undergone a temporoparietal fascial flap harvest. Average injection dose ranged from 20 to 60 units with an average duration of effect ranging from 2 weeks to 4 months.
Results
All patients experienced significant relief of chronic head pain and returned for additional peri-incisional botulinum toxin injections, suggesting meaningful patient-perceived value.
Conclusions
Botulinum toxin therapy may represent a novel treatment for intractable head pain following lateral skull base surgery and temporoparietal fascial flap harvest. This study represents a small case series and, although 100% of the patients who were treated significantly improved, future inquiry is necessary to confirm these findings.
We report here the case of four patients presenting with delayed-onset temporal pain after pterional craniotomy. They reported similar symptoms: attacks of pain over the temporal region, ipsilateral to the operative site, irradiating around the eye and lasting from 10 min to 1 h. All patients had hy...
