Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Sensory Complications in Patients after Scalp Mass Excision and Its Anatomical Considerations

  • Yang, Jin Seo (Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Choi, Hyuk Jai (Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Cho, Yong Jun (Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Kang, Suk Hyung (Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University)
  • Received : 2013.11.11
  • Accepted : 2014.04.23
  • Published : 2014.04.28
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Abstract

Objective : To evaluate the incidence of postsurgical sensory complications in patients with scalp masses and classify the locations of them from a surgical standpoint according to anatomical considerations. Methods : A total of 121 patients who underwent surgery for scalp mass were included in this study. The authors reviewed medical records and preoperative radiologic images. We investigated the complications related to sensory changes after procedure. Enrolled patients have been divided into three groups. Group A included patients with tumors above the superior nuchal line (SNL), Group B with tumors within the trapezius muscle area and patients who had tumors on the lateral trapezius muscle area were assigned to Group C. We compared the incidence related to postoperative sensory complications and summarized their additional treatments for these with clinical outcome. Results : There were 12 patients (10%) with sensory complications related on the mass excision site (Group A : 1 patient, Group B : 2 patients, Group C : 9 patients). Six patients were affected with lesser occipital nerve (LON), 2 patients on greater occipital nerve (GON) and 4 patients on GON and LON. Over 6 months after surgery, two of the twelve patients with sensory complications did not have complete recovered pain in spite of proper medications and local chemical neurolysis with 1.0% lidocaine and dexamethasone. Conclusion : Occipital neuropathy should be considered as a complication related excision of scalp mass. The sensory complications are more frequent in Group C because of the anatomical characteristics of the occipital nerves and there were no statistical difference for other variables.

Keywords

References

  1. Ahn NU, Ahn UM, Ipsen B, An HS : Mechanical neck pain and cervicogenic headache. Neurosurgery 60 (1 Supp1 1) : S21-S27, 2007
  2. Arai T, Ishikawa K, Saito T, Hashimoto Y, Asai T, Okuda Y : Distance from the external occipital protuberance to the occipital artery for occipital nerve block. J Anesth 27 : 801-802, 2013 https://doi.org/10.1007/s00540-013-1587-7
  3. Biousse V, D'Anglejan-Chatillon J, Massiou H, Bousser MG : Head pain in non-traumatic carotid artery dissection : a series of 65 patients. Cephalalgia 14 : 33-36, 1994 https://doi.org/10.1046/j.1468-2982.1994.1401033.x
  4. Choi HJ, Oh IH, Choi SK, Lim YJ : Clinical outcomes of pulsed radiofrequency neuromodulation for the treatment of occipital neuralgia. J Korean Neurosurg Soc 51 : 281-285, 2012 https://doi.org/10.3340/jkns.2012.51.5.281
  5. Conroy E, Laing A, Kenneally R, Poynton AR : C1 lateral mass screwinduced occipital neuralgia : a report of two cases. Eur Spine J 19 : 474- 476, 2010 https://doi.org/10.1007/s00586-009-1178-3
  6. Diamond MP, Freeman ML : Clinical implications of postsurgical adhesions. Hum Reprod Update 7 : 567-576, 2001 https://doi.org/10.1093/humupd/7.6.567
  7. Ducic I, Moriarty M, Al-Attar A : Anatomical variations of the occipital nerves : implications for the treatment of chronic headaches. Plast Reconstr Surg 123 : 859-863; discussion 864, 2009 https://doi.org/10.1097/PRS.0b013e318199f080
  8. Gille O, Lavignolle B, Vital JM : Surgical treatment of greater occipital neuralgia by neurolysis of the greater occipital nerve and sectioning of the inferior oblique muscle. Spine (Phila Pa 1976) 29 : 828-832, 2004 https://doi.org/10.1097/01.BRS.0000112069.37836.2E
  9. Gunnarsson T, Massicotte EM, Govender PV, Raja Rampersaud Y, Fehlings MG : The use of C1 lateral mass screws in complex cervical spine surgery : indications, techniques, and outcome in a prospective consecutive series of 25 cases. J Spinal Disord Tech 20 : 308-316, 2007 https://doi.org/10.1097/01.bsd.0000211291.21766.4d
  10. Haldeman S, Dagenais S : Cervicogenic headaches : a critical review. Spine J 1 : 31-46, 2001 https://doi.org/10.1016/S1529-9430(01)00024-9
  11. Hammond SR, Danta G : Occipital neuralgia. Clin Exp Neurol 15 : 258- 270, 1978
  12. International Headache Society Headache Classification Subcommittee : The International Classification of Headache Disorders, ed 2. Oxford : Blackwell Pub, 2004
  13. Jeon SJ, Park SH, Ryu KS, Cho BM, Oh SM : Clinical and radiological analysis of scalp masses. J Korean Neurosurg Soc 32 : 559-563, 2002
  14. Jung SJ, Moon SK, Kim TY, Eom KS : A case of occipital neuralgia in the greater and lesser occipital nerves treated with neurectomy by using transcranial Doppler sonography : technical aspects. Korean J Pain 24 : 48-52, 2011 https://doi.org/10.3344/kjp.2011.24.1.48
  15. Jürgens TP, Muller P, Seedorf H, Regelsberger J, May A : Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain. J Headache Pain 13 : 199-213, 2012 https://doi.org/10.1007/s10194-012-0417-x
  16. Lucchesi C, Puglioli M, Gori S : Occipital neuralgia : a symptomatic case caused by an abnormal left vertebral artery. Neurol Sci 34 : 243-245, 2013 https://doi.org/10.1007/s10072-012-0964-6
  17. Mosser SW, Guyuron B, Janis JE, Rohrich RJ : The anatomy of the greater occipital nerve : implications for the etiology of migraine headaches. Plast Reconstr Surg 113 : 693-697; discussion 698-700, 2004 https://doi.org/10.1097/01.PRS.0000101502.22727.5D
  18. Park TS, Kim YS : Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy. Arthroscopy 21 : 631, 2005
  19. Rhee WT, You SH, Kim SK, Lee SY : Troublesome occipital neuralgia developed by c1-c2 harms construct. J Korean Neurosurg Soc 43 : 111- 113, 2008 https://doi.org/10.3340/jkns.2008.43.2.111
  20. Shavell VI, Saed GM, Diamond MP : Review : cellular metabolism : contribution to postoperative adhesion development. Reprod Sci 16 : 627-634, 2009 https://doi.org/10.1177/1933719109332826
  21. Tahir M, Corbett S : Lesser occipital nerve neurotmesis following shoulder arthroscopy. J Shoulder Elbow Surg 22 : e4-e6, 2013 https://doi.org/10.1016/j.jse.2012.10.041
  22. Trabold O, Wagner S, Wicke C, Scheuenstuhl H, Hussain MZ, Rosen N, et al. : Lactate and oxygen constitute a fundamental regulatory mechanism in wound healing. Wound Repair Regen 11 : 504-509, 2003 https://doi.org/10.1046/j.1524-475X.2003.11621.x
  23. Tubbs RS, Salter EG, Wellons JC, Blount JP, Oakes WJ : Landmarks for the identification of the cutaneous nerves of the occiput and nuchal regions. Clin Anat 20 : 235-238, 2007 https://doi.org/10.1002/ca.20297
  24. Yoon SH, Park SH : A study of 77 cases of surgically excised scalp and skull masses in pediatric patients. Childs Nerv Syst 24 : 459-465, 2008 https://doi.org/10.1007/s00381-007-0523-2

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