Peri‐Incisional Botulinum Toxin Therapy for Treatment of Intractable Head Pain After Lateral Skull Base Surgery: A Case Series

Dang, Sabina; Shinn, Justin R.; Sowder, Justin C.; Ries, William Russell; Stephan, Scott J.

doi:10.1111/head.13616

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…From the reported injection site diagram there was definite involvement of cranial suture lines although the authors did not comment on this. Another study looked at four patients with persistent PCH (8). Dosing ranged from 10-80 units along the craniotomy site.…”

Section: Discussionmentioning

confidence: 99%

Onabotulinumtoxina (craniotomy scar combined with cranial suture line injections) for persistent post craniotomy headache: Case series with long-term follow-up

Leon,

Rozen,

Bhatt

2024

Cephalalgia

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Background There is no defined preventive treatment protocol for persistent post-craniotomy headache. In several small case series and individual case reports onabotulinumtoxinA injected into the craniotomy scar has shown possible efficacy. What is lacking is long term follow-up and if focusing on the cranial suture lines along with the craniotomy scar can enhance improvement and provide more sustained benefit. Methods Retrospective chart review with case series. Results Four patients (three women, one man) with ICHD-3 defined persistent post craniotomy headache were treated using a novel onabotulinumtoxinA injection protocol. All the patients presented with continuous head pain of moderate to severe intensity. All had severe allodynia on the side of their craniotomy. All had significant reduction in quality of life. Our application of onabotulinumtoxinA involved injection into both the surgical scar and the transected/irritated cranial suture lines noted on neuroimaging and physical examination. With treatment all patients demonstrated significant benefit including a reduction in daily pain intensity (75%-100%), developing periods of pain freedom (2–7 days per week) and having a dramatic improvement in quality of life (close to 100% in all). The benefit was sustained for at least five years of follow-up. Conclusion From our case series it appears that injection not only along the painful craniotomy scar but into the involved cranial suture lines provides positive efficacy and sustained improvement in patients with persistent post craniotomy headache.

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Section: Discussionmentioning

confidence: 99%

Onabotulinumtoxina (craniotomy scar combined with cranial suture line injections) for persistent post craniotomy headache: Case series with long-term follow-up

Leon,

Rozen,

Bhatt

2024

Cephalalgia

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“…After applying our inclusion/exclusion criteria, 19 articles remained with 131 patients who underwent intervention for chronic PCH (Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Studies ranged in level of evidence from IIa to V. Interventions for nerve-related pain included local anesthetic or botulinum injection (n = 12), occipital nerve stimulation (n = 15), nerve excision with or without dermal fat grafting (n = 49), and nerve decompression (n = 1). Management of adhesion-related pain included cranioplasty (n = 26) and dural adhesion release (n = 1).…”

Section: Systematic Reviewmentioning

confidence: 99%

Expanding Our Role in Headache Management

et al. 2023

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Background Chronic postcraniotomy headache (PCH) is common and debilitating. Unfortunately, the literature on this topic is sparse without clear management algorithms. Possible etiologies of PCH include nerve injury and/or entrapment, hardware, dural adhesions, or musculoskeletal injury. The purpose of this study was to present the results of both a systematic review of the literature and a single-center case series, both of which informed the development of a novel treatment algorithm that may be applied to this patient population Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic review of the literature, identifying articles describing the surgical management of PCH. A retrospective chart review was performed to identify patients who met the criteria for PCH treated at our institution. A patient's history and physical examination determined the etiology and management, and pain severity scores were the primary outcome measured. Results Nineteen articles encompassing 131 patients described surgical management techniques for PCH. 83 patients (63.3%) had complete resolution of pain (χ 2 = 52.1, P < 0.0001). At our institution, 19 patients underwent surgical management for PCH. A significant reduction in pain scores from 7.57 to 2.16 (P < 0.001) was demonstrated, and 84 percent of patients achieved complete or significant pain reduction. Conclusions Through a literature review and our own case series, we demonstrate that surgical management of PCH can achieve remarkable results. Plastic surgeons, with their expanding role in treating migraine and headaches, are well suited to manage these patients. We present an algorithmic approach to simplify the management of this common and debilitating condition.

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The Effect on Quality of Life after Three-Dimensional Intensity-Modulated Radiation Therapy in Patients with Low-Grade Glioma

Chen

Rao

Huang

2022

Computational and Mathematical Methods in Medicine

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Objective. To investigate the effect of three-dimensional intensity-modulated radiation therapy (IMRT) that accurately target delineation on quality of life (Qol) in patients with low-grade gliomas. Methods. From February 2015 to December 2019, 100 patients with low-grade gliomas were randomly divided into three-dimensional conformal radiotherapy control group ( n = 50 ) and three-dimensional IMRT research group ( n = 50 ). The scores of the Mini-Cog Assessment (Mini-Cog) and Montreal Cognitive Assessment Scale (MoCA), the self-care ability score (BI), and the effect of symptom improvement and the quality of life SF-36 score were compared between the two groups. Results. After radiotherapy, the self-care ability of patients in the two groups was significantly improved, and the improvement of study group was better than that of the control group ( P < 0.05 ). The Mini-Cog and MOCA scores in the study group were significantly higher than those in the control group ( P < 0.05 ). In addition, the symptom improvement effect and quality of life of the patients in the study group were also significantly better than those in the control group ( P < 0.05 ). The scores of SDS and SAS of patients who underwent three-dimensional conformal IMRT were significantly lower than those of the control group. There was no significant difference in mortality between the two groups. Conclusion. Three-dimensional conformal intensity-modulated radiation therapy can delineate the target volume more accurately, regulate the intensity of radiation, and improve the symptoms and quality of life of patients with low-grade gliomas.

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Peri‐Incisional Botulinum Toxin Therapy for Treatment of Intractable Head Pain After Lateral Skull Base Surgery: A Case Series

Cited by 4 publications

References 24 publications

Onabotulinumtoxina (craniotomy scar combined with cranial suture line injections) for persistent post craniotomy headache: Case series with long-term follow-up

Onabotulinumtoxina (craniotomy scar combined with cranial suture line injections) for persistent post craniotomy headache: Case series with long-term follow-up

Expanding Our Role in Headache Management

The Effect on Quality of Life after Three-Dimensional Intensity-Modulated Radiation Therapy in Patients with Low-Grade Glioma

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