Raposio Edoardo, Simonacci Francesco
Plastic Surgery Division, Department of Surgical Sciences and Integrated Diagnostics - DISC, University of Genoa, Genoa, Italy.
Plast Reconstr Surg Glob Open. 2020 Apr 29;8(4):e2813. doi: 10.1097/GOX.0000000000002813. eCollection 2020 Apr.
The World Health Organization ranked migraine as the 19th worldwide disease causing disability. Recent insights into the pathogenesis of migraine headache substantiate a neuronal hyperexcitability and inflammation involving compressed peripheral craniofacial nerves, and these trigger points can be eliminated by surgery. In this study, we report our experience with minimally invasive surgical procedures for frontal migraine headache treatment.
From June 2011 to May 2019, we performed 70 frontal migraine decompression surgeries of both supratrochlear and supraorbital nerves (65 bilateral and 5 unilateral) by an endoscopic or transpalpebral approach. In 24 patients (34.2%), frontal migraine emerges as a secondary trigger point following primary occipital and/or temporal migraine surgery.
After a mean follow-up of 24 months (range, 3-97 months), patients with frontal trigger site migraine reported a 94% positive response to surgery (32% complete relief and 62% significant improvement); 6% had no change in their symptoms.
Based on our experience, the operation has not caused any serious complication or side effects, and surgical decompression of supraorbital and supratrochlear nerves might be recommended to patients who suffer from a moderate to severe chronic frontal migraine not responding to conventional therapy.
世界卫生组织将偏头痛列为全球导致残疾的第19种疾病。最近对偏头痛发病机制的深入研究证实了神经元的过度兴奋和炎症，涉及受压的周围颅面部神经，这些触发点可通过手术消除。在本研究中，我们报告了我们采用微创手术治疗额部偏头痛的经验。
2011年6月至2019年5月，我们通过内镜或经睑入路对70例患者进行了滑车上神经和眶上神经的额部偏头痛减压手术（65例双侧，5例单侧）。在24例患者（34.2%）中，额部偏头痛是原发性枕部和/或颞部偏头痛手术后出现的继发性触发点。
平均随访24个月（范围3 - 97个月）后，额部触发点偏头痛患者对手术的阳性反应率为94%（32%完全缓解，62%明显改善）；6%的患者症状无变化。
根据我们的经验，该手术未引起任何严重并发症或副作用，对于患有中度至重度慢性额部偏头痛且对传统治疗无反应的患者，建议行眶上神经和滑车上神经减压手术。
