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词条 Migraine surgery
释义

  1. Indications and patient selection

  2. Surgical procedures

      Anterior Nerves    Nerves of the Temple Region    Posterior Nerves    Nerves of the Nose  

  3. Surgical Outcomes

  4. References

Migraine surgery is a surgical operation undertaken with the goal of reducing or preventing migraines. Migraine surgery most often refers to surgical decompression of one or several nerves in the head and neck which have been shown to trigger migraine symptoms in many migraine sufferers.[1][2][3][4] Following the development of nerve decompression techniques for the relief of migraine pain in the year 2000, these procedures have been extensively studied and shown to be effective in appropriate candidates.[5][6][7] The nerves that are most often addressed in migraine surgery are found outside of the skull, in the face and neck, and include the supra-orbital and supra-trochlear nerves in the forehead, the zygomaticotemporal nerve and auriculotemporal nerves in the temple region, and the greater occipital, lesser occipital, and third occipital nerves in the back of the neck.[8][1][9][3][2][4][10][11][12] Nerve impingement in the nasal cavity has additionally been shown to be a trigger of migraine symptoms.

Indications and patient selection

Migraine surgery is usually reserved for migraine patients who fail more conservative therapy or who cannot tolerate the side effects of drugs used to treat their migraines. Appropriate patients are screened using injections of local anesthesia to provide a temporary nerve block. In some cases, Botox may be used to provide temporary decompression of the nerve. Patients who respond to nerve blocks often see an immediate though temporary reduction in their pain by "shutting off" the nerve that is triggering the migraine, while pain relief following Botox injections is provided by relaxation of nearby muscle tissue that may be compressing the nerve. Patients who respond well to these screening procedures are felt to be excellent candidates for migraine surgery.[13][6][14][15]

Surgical procedures

Migraine surgery is an outpatient procedure which addresses peripheral nerves through limited incisions. Depending on the symptoms of the patient and the screening results following nerve blocks or Botox, different areas of the head and neck may be addressed to treat the nerves found to be the migraine trigger in a given patient. Migraine surgery is always individualized to each patient's symptoms and anatomy.

Anterior Nerves

Nerves found in the forehead (supra-orbital and supra-trochlear nerves) are either addressed using endoscopic surgery or by using an incision in the crease of the upper eyelid.[16][17] Structures that are found pressing on the nerves here are released and may include bone at the upper orbit, fascia, blood vessels, or muscle tissue. The supra-orbital and supra-trochlear nerves travel through the corrugator supercilii muscle which enables frowning of the brow. These nerves are released from these muscles so they may lie free of pressure from these muscle structures. Small blood vessels which travel with these nerves may be divided to prevent pressure as well. In the bony notch where these nerves exit the eye socket, small pieces of bone or connective tissue may be removed so undue pressure is not placed on the nerves in this region.[18][19][20]

Nerves of the Temple Region

The zygomaticotemporal nerve and auriculotemporal nerves are found in areas between the top of the ear and the lateral portion of the eye, in different areas of the temple. These nerves can also be addressed by endoscopic techniques, or well hidden small incisions. Blood vessels next to or crossing these nerves are often found to be the source of compression, and these blood vessels may be divided to prevent irritation of these nerves. Associated temporal muscle release in the region of these nerves may also be indicated.[21] Because these nerves are very small and provide feeling to small regions of the scalp, they are often cut or avulsed, allowing the ends to retract into muscle tissue to prevent neuroma formation.[22]

Posterior Nerves

Chronic irritation of the occipital nerves is called occipital neuralgia and is frequently the cause of migraine symptoms. The greater occipital and third occipital nerves are addressed through an incision at the base of the scalp in the upper neck by either a vertical or transverse incision. Incisions are usually placed within the hairline. The greater occipital nerve travels through several muscle layers (including the trapezius muscle and splenius capitis muscle) where it is often compressed, and therefore surgery for this nerve involves releasing it from tight muscle and fascia in the upper neck. Blood vessels found crossing the nerve such as the occipital artery may be divided in order to avoid chronic pressure and irritation of the greater occipital nerve.[2][23] The third occipital nerve is a small nerve that travels near the greater occipital nerve and may treated similarly in order to alleviate chronic irritation.[11]

The lesser occipital nerve is a small nerve that has additionally been found to be associated with migraine pain. This nerve is found near the sternocleidomastoid muscle and may be decompressed or divided here through a small incision. As this small nerve provides feeling for a small region of the scalp, the minimal numbness resulting from the division of this nerve often goes un-noticed.[8][11]

Nerves of the Nose

The nerves of the nasal lining may be impinged by structures in the nose such as the nasal septum and turbinates. Nasal surgery to decompress these regions may include septoplasty, turbinectomy, or other rhinoplasty procedures.[24]

Surgical Outcomes

Though initially thought to be experimental surgery, the benefits of migraine surgery have now been well documented. Followup data has shown that 88% of migraine surgery patients experienced a positive response to the procedure after 5 years. 29% of patients have been shown to achieve complete elimination of their migraine disease, while an additional 59% of patients reported a significant decrease in their pain and symptoms 5 years following their migraine surgery. 12% of patients undergoing migraine surgery reported no change in their symptoms after 5 years.[5][6][7][25]

Migraine surgery has additionally been studied in a socioeconomic context and has been shown to reduce both direct and indirect costs associated with migraine disease. Such costs after migraine surgery have been shown to be reduced by a median of $3,949 per patient per year.[26]

References

1. ^1 {{cite journal | vauthors = Ducic I, Moriarty M, Al-Attar A | title = Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches | journal = Plastic and Reconstructive Surgery | volume = 123 | issue = 3 | pages = 859–63; discussion 864 | date = March 2009 | pmid = 19319048 | doi = 10.1097/prs.0b013e318199f080 }}
2. ^1 2 {{cite journal | vauthors = Janis JE, Hatef DA, Reece EM, McCluskey PD, Schaub TA, Guyuron B | title = Neurovascular compression of the greater occipital nerve: implications for migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 126 | issue = 6 | pages = 1996–2001 | date = December 2010 | pmid = 21124138 | doi = 10.1097/prs.0b013e3181ef8c6b }}
3. ^1 {{cite journal | vauthors = Ascha M, Kurlander DE, Sattar A, Gatherwright J, Guyuron B | title = In-Depth Review of Symptoms, Triggers, and Treatment of Occipital Migraine Headaches (Site IV) | journal = Plastic and Reconstructive Surgery | volume = 139 | issue = 6 | pages = 1333e-1342e | date = June 2017 | pmid = 28538577 | doi = 10.1097/prs.0000000000003395 }}
4. ^1 {{cite journal | vauthors = Mosser SW, Guyuron B, Janis JE, Rohrich RJ | title = The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 113 | issue = 2 | pages = 693–7; discussion 698–700 | date = February 2004 | pmid = 14758238 | doi = 10.1097/01.prs.0000101502.22727.5d }}
5. ^1 {{cite journal | vauthors = Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S | title = A placebo-controlled surgical trial of the treatment of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 124 | issue = 2 | pages = 461–8 | date = August 2009 | pmid = 19644260 | doi = 10.1097/prs.0b013e3181adcf6a }}
6. ^1 2 {{cite journal | vauthors = Janis JE, Barker JC, Javadi C, Ducic I, Hagan R, Guyuron B | title = A review of current evidence in the surgical treatment of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 134 | issue = 4 Suppl 2 | pages = 131S-41S | date = October 2014 | pmid = 25254996 | doi = 10.1097/prs.0000000000000661 }}
7. ^1 {{cite journal | vauthors = Guyuron B, Kriegler JS, Davis J, Amini SB | title = Five-year outcome of surgical treatment of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 127 | issue = 2 | pages = 603–8 | date = February 2011 | pmid = 20966820 | doi = 10.1097/prs.0b013e3181fed456 }}
8. ^1 {{cite journal | vauthors = Lee M, Brown M, Chepla K, Okada H, Gatherwright J, Totonchi A, Alleyne B, Zwiebel S, Kurlander D, Guyuron B | title = An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 132 | issue = 6 | pages = 1551–6 | date = December 2013 | pmid = 24005368 | doi = 10.1097/prs.0b013e3182a80721 }}
9. ^{{cite journal | vauthors = Janis JE, Hatef DA, Hagan R, Schaub T, Liu JH, Thakar H, Bolden KM, Heller JB, Kurkjian TJ | title = Anatomy of the supratrochlear nerve: implications for the surgical treatment of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 131 | issue = 4 | pages = 743–50 | date = April 2013 | pmid = 23249981 | doi = 10.1097/prs.0b013e3182818b0c }}
10. ^{{cite journal | vauthors = Chim H, Okada HC, Brown MS, Alleyne B, Liu MT, Zwiebel S, Guyuron B | title = The auriculotemporal nerve in etiology of migraine headaches: compression points and anatomical variations | journal = Plastic and Reconstructive Surgery | volume = 130 | issue = 2 | pages = 336–41 | date = August 2012 | pmid = 22842409 | doi = 10.1097/prs.0b013e3182589dd5 }}
11. ^1 2 {{cite journal | vauthors = Dash KS, Janis JE, Guyuron B | title = The lesser and third occipital nerves and migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 115 | issue = 6 | pages = 1752–8; discussion 1759–60 | date = May 2005 | pmid = 15861086 | doi = 10.1097/01.prs.0000161679.26890.ee }}
12. ^{{cite journal | vauthors = Janis JE, Hatef DA, Thakar H, Reece EM, McCluskey PD, Schaub TA, Theivagt C, Guyuron B | title = The zygomaticotemporal branch of the trigeminal nerve: Part II. Anatomical variations | journal = Plastic and Reconstructive Surgery | volume = 126 | issue = 2 | pages = 435–42 | date = August 2010 | pmid = 20375758 | doi = 10.1097/prs.0b013e3181e094d7 }}
13. ^{{cite journal | vauthors = Lee M, Monson MA, Liu MT, Reed D, Guyuron B | title = Positive botulinum toxin type a response is a prognosticator for migraine surgery success | journal = Plastic and Reconstructive Surgery | volume = 131 | issue = 4 | pages = 751–7 | date = April 2013 | pmid = 23542247 | doi = 10.1097/prs.0b013e3182818b7f }}
14. ^{{cite journal | vauthors = Guyuron B, Nahabet E, Khansa I, Reed D, Janis JE | title = The Current Means for Detection of Migraine Headache Trigger Sites | journal = Plastic and Reconstructive Surgery | volume = 136 | issue = 4 | pages = 860–7 | date = October 2015 | pmid = 26397259 | doi = 10.1097/prs.0000000000001572 }}
15. ^{{cite journal | vauthors = Janis JE, Dhanik A, Howard JH | title = Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression | journal = Plastic and Reconstructive Surgery | volume = 128 | issue = 1 | pages = 123–31 | date = July 2011 | pmid = 21701329 | doi = 10.1097/prs.0b013e3182173d64 }}
16. ^{{cite journal | vauthors = Gfrerer L, Maman DY, Tessler O, Austen WG | title = Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes | journal = Plastic and Reconstructive Surgery | volume = 134 | issue = 4 | pages = 771–8 | date = October 2014 | pmid = 24945947 | doi = 10.1097/prs.0000000000000507 }}
17. ^{{cite journal | vauthors = Liu MT, Chim H, Guyuron B | title = Outcome comparison of endoscopic and transpalpebral decompression for treatment of frontal migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 129 | issue = 5 | pages = 1113–9 | date = May 2012 | pmid = 22544095 | doi = 10.1097/prs.0b013e31824a2c31 }}
18. ^{{cite journal | vauthors = Chepla KJ, Oh E, Guyuron B | title = Clinical outcomes following supraorbital foraminotomy for treatment of frontal migraine headache | journal = Plastic and Reconstructive Surgery | volume = 129 | issue = 4 | pages = 656e-62e | date = April 2012 | pmid = 22456379 | pmc = 3315686 | doi = 10.1097/prs.0b013e3182450b64 }}
19. ^{{cite journal | vauthors = Hagan RR, Fallucco MA, Janis JE | title = Supraorbital Rim Syndrome: Definition, Surgical Treatment, and Outcomes for Frontal Headache | journal = Plastic and Reconstructive Surgery Global Open | volume = 4 | issue = 7 | pages = e795 | date = July 2016 | pmid = 27536474 | pmc = 4977123 | doi = 10.1097/gox.0000000000000802 }}
20. ^{{cite journal | vauthors = Fallucco M, Janis JE, Hagan RR | title = The anatomical morphology of the supraorbital notch: clinical relevance to the surgical treatment of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 130 | issue = 6 | pages = 1227–33 | date = December 2012 | pmid = 23190806 | doi = 10.1097/prs.0b013e31826d9c8d }}
21. ^{{cite journal | vauthors = Kurlander DE, Punjabi A, Liu MT, Sattar A, Guyuron B | title = In-depth review of symptoms, triggers, and treatment of temporal migraine headaches (Site II) | journal = Plastic and Reconstructive Surgery | volume = 133 | issue = 4 | pages = 897–903 | date = April 2014 | pmid = 24675192 | doi = 10.1097/prs.0000000000000045 }}
22. ^{{cite journal | vauthors = Guyuron B, Harvey D, Reed D | title = A Prospective Randomized Outcomes Comparison of Two Temple Migraine Trigger Site Deactivation Techniques | journal = Plastic and Reconstructive Surgery | volume = 136 | issue = 1 | pages = 159–65 | date = July 2015 | pmid = 25829156 | doi = 10.1097/prs.0000000000001322 }}
23. ^{{cite journal | vauthors = Chmielewski L, Liu MT, Guyuron B | title = The role of occipital artery resection in the surgical treatment of occipital migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 131 | issue = 3 | pages = 351e-6e | date = March 2013 | pmid = 23446584 | doi = 10.1097/prs.0b013e31827c6f71 }}
24. ^{{cite journal | vauthors = Behin F, Behin B, Bigal ME, Lipton RB | title = Surgical treatment of patients with refractory migraine headaches and intranasal contact points | journal = Cephalalgia | volume = 25 | issue = 6 | pages = 439–43 | date = June 2005 | pmid = 15910568 | doi = 10.1111/j.1468-2982.2004.00877.x }}
25. ^{{cite journal | vauthors = Guyuron B, Lineberry K, Nahabet EH | title = A retrospective review of the outcomes of migraine surgery in the adolescent population | journal = Plastic and Reconstructive Surgery | volume = 135 | issue = 6 | pages = 1700–5 | date = June 2015 | pmid = 26017602 | doi = 10.1097/prs.0000000000001270 }}
26. ^{{cite journal | vauthors = Faber C, Garcia RM, Davis J, Guyuron B | title = A socioeconomic analysis of surgical treatment of migraine headaches | journal = Plastic and Reconstructive Surgery | volume = 129 | issue = 4 | pages = 871–7 | date = April 2012 | pmid = 22183497 | doi = 10.1097/prs.0b013e318244217a }}
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2 : Migraine|Neurosurgery
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