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Delayed-onset post-craniotomy headache responsive to botulinum toxin A: a case series

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Abstract

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 hypertrophy of at least one part of the temporalis muscle. All responded dramatically to botulinum toxin A injection (25 to 50 Botox® units) into the temporalis muscle. We suggest that the headaches were caused by aberrant nerve regeneration following surgical injury to the frontal branch of the facial nerve.

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References

  1. Aoki KR, Francis J (2011) Updates on the antiociceptive mechanism hypothesis of botulinum toxin A. Parkinsonism Relat Disord 17(Suppl 1):S28–S33

    Article  PubMed  Google Scholar 

  2. Choi D, Raisman G (2004) After facial nerve damage, regenerating axons become aberrant throughout the length of the nerve and not only at the site of the lesion: an experimental study. Br J Neurosurg 18:45–48

    Article  CAS  PubMed  Google Scholar 

  3. Hallett M (2015) Explanation of timing of botulinum neurotoxin effects, onset and duration, and clinical ways of influencing them. Toxicon 107(PtA):64–67

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Headache Classification Committee of the International Headache Society (2013) The International Classification of headache disorders, 3rd edition (beta version). Cephalagia 33:629–808

    Article  Google Scholar 

  5. Kadri PA, Al-Mefty O (2004) The anatomical basis for surgical preservation of temporal muscle. J Neurosurg 100:517–522

    Article  PubMed  Google Scholar 

  6. Matak I, Lackovic Z (2014) Botulinum toxin A, brain and pain. Prog Neurobiol 119-120:39–59

    Article  CAS  PubMed  Google Scholar 

  7. Rocha-Filho PA, Fujarra FJ, Gherpelli JL, Rabello GD, de Siqueira JT (2007) The long-term effect of craniotomy on temporalis muscle function. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:17–21

    Article  Google Scholar 

  8. Rocha-Filho P, Gherpelli J, de Siqueira J, Rabello GD (2010) Post-craniotomy headache: a proposed revision of IHS diagnostic criteria. Cephalalgia 30:560–566

    Article  CAS  PubMed  Google Scholar 

  9. Rocha-Filho PA (2015) Post-craniotomy headache: a clinical view with a focus on the persistent form. Headache 55(5):733–738

    Article  PubMed  Google Scholar 

  10. Schaller B, Baumann A (2003) Headache after removal of vestibular schwannoma via the retrosigmoid approach: a long-term follow-up-study. Otolaryngol Head Neck Surg 128:387–395

    Article  PubMed  Google Scholar 

  11. Valls-Solé J (2013) Facial nerve palsy and hemifacial spasm. Handb Clin Neurol 115:367–380

    Article  PubMed  Google Scholar 

  12. Yaşargil MG, Reichman MV, Kubik S (1987) Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. J Neurosurg 67:463–466

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Mr. Tyler Clay for English correction.

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Authors and Affiliations

  1. Department of Neurosurgery, CHU Limoges, Limoges, France

    Danièle Ranoux, Henri Salle & François Caire

  2. Pain Center, CHU Limoges, Limoges, France

    Gaëlle Martiné & Gaëlle Espagne

  3. University of Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France

    François Caire

Authors
  1. Danièle Ranoux
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  2. Gaëlle Martiné
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  3. Gaëlle Espagne
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  4. Henri Salle
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  5. François Caire
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Corresponding author

Correspondence to François Caire.

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Conflict of interest

Dr. Ranoux is a consultant for Allergan and reports grants, personal fees and non-financial support from Allergan, outside the submitted work. The other co-authors have no conflict of interest to declare.

Funding statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethics approval

This study has been approved by the Ethics Committee of Limoges University Hospital.

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Comments

Postcraniotomy pain associated with temporal muscle hypertrophy was successfully treated with local botulinum toxin injections in four patients. The authors are to be congratulated for their novel observation and therapeutic ingenuity. As they rightly point out, postcraniotomy pain is under-reported in the literature and has a multifaceted pathophysiology. In this small patient cohort hypertrophy of the painful temporal muscle suggested the use of botulinum toxin. The up to 2 week latency for pain relief suggests a secondary inflammatory component to the pain.

Zvi Harry Rapaport

Petah Tikva, Israel

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Ranoux, D., Martiné, G., Espagne, G. et al. Delayed-onset post-craniotomy headache responsive to botulinum toxin A: a case series. Acta Neurochir 159, 1375–1378 (2017). https://doi.org/10.1007/s00701-017-3215-z

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  • DOI: https://doi.org/10.1007/s00701-017-3215-z

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