Dirnberger Franz, Becker Klaus
Department of Plastic Surgery, Wilhelminenspital, Vienna, Austria.
Plast Reconstr Surg. 2004 Sep 1;114(3):652-7; discussion 658-9. doi: 10.1097/01.prs.0000131906.27281.17.
The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery (106: 429, 2000). Sixty patients were operated on between June of 2001 and June of 2002; postoperative follow-up ranged between 6 and 18 months. Patients' charts were reviewed to confirm the diagnosis of migraine headache according to the criteria of the International Headache Society. Sixty patients (13 men and 47 women) from Austria and four neighboring countries took part in the study. The patients were divided into three groups, based on the severity of their migraines: group A comprised patients with up to 4 days of migraine per month; group B included patients with 5 to 14 days of migraine per month; and group C was composed of patients with more than 15 days of headache per month ("permanent headache") or evidence of drug abuse and drug-related headaches. The effectiveness of the operation was evaluated using the following factors: percentage reduction of headache days; percentage reduction of drugs; percentage reduction of side effects, severity of headaches, and response to drugs; and patient grade of personal satisfaction, using a scale from 1 to 5 [1 = excellent (total elimination of migraine headache) to 5 = insufficient or no improvement]. From the entire group of 60 patients, 17 (28.3 percent) reported a total relief from migraine, 24 (40 percent) reported an essential improvement, and 19 (31.7 percent) reported minimal or no change. Patients with a rather mild form of migraine headache had a much better chance (almost 90 percent in group A and 75 percent in group B) to experience an improvement or total elimination of migraine than those patients (n = 27) from group C with severe migraine, "permanent headaches," and drug-induced headaches. Contrary to the reports by Guyuron, 11 patients who had a very favorable response immediately and in the first weeks after the operation experienced a gradual return of their headaches to preoperative intensity after about 4 postoperative weeks. After 3 months, the results in all patients could be declared permanent. All side effects, such as paraesthesia in the frontal region, disappeared in all patients within 3 to 9 months.
作者是一位整形外科医生（迪尔恩贝格尔）和一位神经科医生（贝克尔），他们在阅读了巴赫曼·居尤伦等人于2000年8月发表在《整形与重建外科杂志》（106: 429, 2000）上的文章后开展了这项研究。2001年6月至2002年6月期间，对60名患者进行了手术；术后随访时间为6至18个月。根据国际头痛协会的标准，查阅患者病历以确诊偏头痛。来自奥地利及四个邻国的60名患者（13名男性和47名女性）参与了该研究。根据偏头痛的严重程度，患者被分为三组：A组为每月偏头痛天数不超过4天的患者；B组包括每月偏头痛天数为5至14天的患者；C组由每月头痛天数超过15天（“持续性头痛”）或有药物滥用及药物相关性头痛证据的患者组成。手术效果通过以下因素进行评估：头痛天数减少的百分比；药物用量减少的百分比；副作用、头痛严重程度及对药物反应的减少百分比；以及患者个人满意度等级，采用1至5分制[1 = 极佳（偏头痛完全消除）至5 = 改善不足或无改善]。在60名患者的整个群体中，17名（28.3%）报告偏头痛完全缓解，24名（40%）报告有显著改善，19名（31.7%）报告改善极小或无变化。偏头痛症状较为轻微的患者比C组中患有严重偏头痛、“持续性头痛”及药物性头痛的患者（n = 27）有更好的机会（A组近90%，B组75%）改善或完全消除偏头痛。与居尤伦的报告相反，11名在术后立即及最初几周反应非常良好的患者，在术后约4周后头痛逐渐恢复到术前强度。3个月后，所有患者均可宣布结果为永久性。所有副作用，如额部感觉异常，在所有患者中3至9个月内均消失。
