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

Area of Science:

• Neurosurgery
• Neurology
• Pain Management

Background:

• Pterional craniotomy is a common neurosurgical approach.
• Delayed-onset pain is a potential complication following cranial surgery.
• Temporal pain and temporalis muscle hypertrophy are underreported sequelae.

Purpose of the Study:

• To describe a series of patients with delayed-onset temporal pain post-pterional craniotomy.
• To investigate the potential cause of this specific type of post-operative pain.
• To evaluate the efficacy of botulinum toxin A as a treatment modality.

Main Methods:

• Case series of four patients.
• Clinical evaluation of pain characteristics and temporalis muscle status.
• Treatment with botulinum toxin A injections into the temporalis muscle.

Main Results:

• All four patients reported delayed-onset temporal pain ipsilateral to the surgical site.
• Patients exhibited hypertrophy of the temporalis muscle.
• Dramatic pain relief was achieved following botulinum toxin A injections (25-50 units).

Conclusions:

• Aberrant nerve regeneration, likely involving the frontal branch of the facial nerve, is a probable cause of delayed temporal pain after pterional craniotomy.
• Botulinum toxin A offers an effective treatment for this condition.
• Further research is warranted to elucidate the precise mechanisms of nerve injury and regeneration.