Assessment of facial pain and headache before and after nasal polyposis surgery with the DyNaChron questionnaire.

OBJECTIVES: Facial pain/headache is reported in 16-67% of nasal polyposis (NP) patients. This wide range may be due to differences in assessment methods. The present prospective study assessed facial pain/headache and quality-of-life (QoL) impact before and after NP surgery. METHODS: Pain was assessed on the DyNaChron self-administered questionnaire in patients undergoing NP surgery, the day before the procedure (V0) and 6 weeks (V1) and 7 months (V2) after. All patients underwent the same nasalization procedure, sparing the middle turbinates when possible. The questionnaire extract comprised 1 item assessing pain, 13 assessing physical impact and 4 assessing psychosocial impact, with responses on visual analog scales (VAS) graded 0 (no discomfort) to 10 (unbearable discomfort). RESULTS: Sixty-three patients (mean age: 50.6±12.8 years; 32 male [50.8%], 31 female [49.2%]) were included. Thirty-seven patients (58.7%) had history of NP surgery. Fifty-two percent reported moderate to severe pain before surgery, 17.5% at 6 weeks, and 22.2% at 7 months. One-third reported no pain preoperatively, versus a half at 6 weeks and 7 months. Scores for the physical and psychosocial impact of pain were improved after surgery. CONCLUSION: Headache/facial pain is frequent in patients for whom NP surgery is indicated. Endoscopic surgery relieves the symptom and its physical and psychosocial impacts. However, one-fifth of patients reported residual postoperative pain.

Suprasellar arachnoid cyst after subdural haemorrhage in an infant. A case based update.

INTRODUCTION: Brain arachnoid cysts (AC) are congenital or acquired malformations. Their prevalence in children ranges between 0.2 and 2.3% of the studied populations. Few reported studies exist where AC appears after a subdural haemorrhage. METHODS: We present one case of a symptomatic suprasellar AC after post-traumatic subdural haemorrhage in an infant. RESULTS: After endoscopic ventriculocystostomy, the child quickly improved and the cyst reduced in size. The child was monitored for 22 months and his neurocognitive development remained normal. CONCLUSION: Our case led us to the hypothesis that the inflammatory process due to subdural haemorrhage may locally result in arachnoiditis, and thus to the creation of a neomembrane, and eventually to cyst formation. This is also the case with the development of post-traumatic spinal AC.