{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T22:41:25Z","timestamp":1777761685692,"version":"3.51.4"},"reference-count":28,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Chronic headache after craniotomy is common and may include neuropathic subtypes (scar neuroma pain, occipital neuralgia). However, no large series has quantified these phenotypes. We conducted a single-center retrospective review (n = 5624 adult craniotomy patients) to estimate the prevalence of post-craniotomy neuropathic pain and to describe its characteristics. Materials and Methods: Institutional records were screened to identify craniotomy patients referred to a multidisciplinary pain clinic (n = 272). Eligible cases were reviewed in tiers: (1) exclusion of primary headache and noncranial pain; (2) identification of \u201cprobable neuropathic cranial pain\u201d based on documented neuropathic features (lancinating\/scalp pain, trigger tenderness, dermatomal distribution); and (3) subgroup categorization into occipital neuralgia-like, supraorbital\/supratrochlear neuralgia-like, and scar-site neuropathic pain phenotypes. The supraorbital\/supratrochlear subgroup was defined by frontal or frontotemporal postoperative pain in the supraorbital region, local tenderness or Tinel-like hypersensitivity over the supraorbital\/supratrochlear course, and\/or response to supraorbital\u2013supratrochlear nerve block. Data extracted included demographics, timing (surgery to pain referral), pain characteristics, and treatments (blocks, radiofrequency, medications). Results: Of 5624 craniotomy patients, 272 (4.8%) had pain clinic encounters. The initial review identified 124 cases with chronic post-craniotomy headache requiring follow-up; after detailed chart classification, probable neuropathic cranial pain was present in 111 cases (2% of the cohort). Among the 111 probable neuropathic cranial pain cases, the dominant regional phenotype was occipital neuralgia-like pain. In addition, eight patients (7.2%) demonstrated a supraorbital\/supratrochlear neuralgia-like phenotype, predominantly after frontal or frontotemporal craniotomies. Scar-site neuropathic pain frequently coexisted with both regional phenotypes, supporting a partially overlapping spectrum rather than mutually exclusive categories. The median time from surgery to pain referral was several months (\u224812\u201318 months). Management commonly included occipital nerve blocks (\u00b1steroid); some patients received pulsed radiofrequency ablation of the occipital nerves, and most were trialed on neuropathic analgesics (gabapentinoids, SNRIs, etc., according to neuropathic pain guidelines). Conclusions: A clinically meaningful subset of post-craniotomy patients develops chronic neuropathic cranial pain, most commonly with occipital, supraorbital\/supratrochlear, or scar-related features. Because most postoperative headaches are managed through neurosurgical follow-up and improve without pain clinic referral, the present cohort likely underestimates the true burden of neuropathic post-craniotomy pain while enriching for its most refractory neuralgic presentations. This is nevertheless the subgroup that must be recognized, discussed with patients, studied prospectively, and targeted in future prevention strategies.<\/jats:p>","DOI":"10.3390\/medicina62050840","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T13:32:22Z","timestamp":1777469542000},"page":"840","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neuropathic Cranial Pain Phenotypes After Craniotomy: A Large, Single-Center Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3411-6266","authenticated-orcid":false,"given":"Shachar Zion","family":"Shemesh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan 5262100, Israel"},{"name":"Gray Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2797-7861","authenticated-orcid":false,"given":"Jose","family":"Asprilla","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan 5262100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2637-8517","authenticated-orcid":false,"given":"Paz","family":"Kelmer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan 5262100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omri","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan 5262100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Itay","family":"Goor-Aryeh","sequence":"additional","affiliation":[{"name":"Pain Center, Sheba Medical Center, Ramat Gan 5262100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yotam","family":"Hadari","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zvi R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan 5262100, Israel"},{"name":"Gray Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7799-7323","authenticated-orcid":false,"given":"Lior","family":"Ungar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan 5262100, Israel"},{"name":"Pain Center, Sheba Medical Center, Ramat Gan 5262100, Israel"},{"name":"Dina Recanati School of Medicine, Reichman University, Herzelia 4610101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1468-2982.2007.01465.x","article-title":"Post-craniotomy headache: Characteristics, behaviour and effect on quality of life in patients operated for supratentorial aneurysms","volume":"28","author":"Gherpelli","year":"2008","journal-title":"Cephalalgia"},{"key":"ref_2","first-page":"124","article-title":"Acute and chronic pain following craniotomy: A review","volume":"56","author":"Matta","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Chowdhury, T., Garg, R., Sheshadri, V., Venkatraghavan, L., Bergese, S.D., Cappellani, R.B., and Schaller, B. 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