The occurrence of neuropathic pain following surgery of brainstem cavernous malformations.

Background This study aimed to assess occurrence and significance of postoperative neuropathic pain in patients with surgically-treated brainstem cavernous malformations (BSCM). Methods Seventy-four BSCM patients surgically treated between 2003 and 2019 were reviewed for the occurrence of postoperative NP and related treatment. We evaluated relevance of BSCM location, preoperative characteristics, influence on functional outcome, postoperative health-related quality of life (HRQOL), and life satisfaction (LS). Results Six out of 74 patients (8%) suffered from NP. Leeds Assessment of Neuropathic Symptoms and Signs scores (LANSS) ranged from 12-16 (mean 14.28 ± 1.6). Visual analog scale pain was 5.2 ± 2.0. NP had no effect on preoperative characteristics or functional outcome. Bodily pain (HRQOL) and vocational time (LS) were significantly decreased in NP compared to non-NP patients. Specific BSCM location (regarding brainstem nuclei involved in pain processing) and other preoperative patient-and BSCM-related parameters were not associated with the occurrence of postoperative NP. Three out of 6 patients were currently under NP-specific treatment. The proportion of patients suffering from postoperative NP (8%) was substantially higher as compared to previously published studies. The pain affected the HRQOL of patients, most of whom were insufficiently treated and not satisfied with treatment results. Conclusion Our findings may help raising awareness for postoperative NP in BSCM, which is essential to improve diagnosis and initiation of proper treatment, as well as preoperative informed consent of patients.